Media Wiki - User contributions [en]

User:Bahzad.moeeni

2022-01-10T21:59:39Z

Snkennedy3327: Creating user page for new user.

i am a MBA graduate from a top university in India.

User talk:Bahzad.moeeni

2022-01-10T21:59:39Z

Snkennedy3327: Welcome!

'''Welcome to ''Media Wiki''!'''
We hope you will contribute much and well.
You will probably want to read the [https://www.mediawiki.org/wiki/Special:MyLanguage/Help:Contents help pages].
Again, welcome and have fun! [[User:Snkennedy3327|Steve Kennedy]] ([[User talk:Snkennedy3327|talk]]) 21:59, 10 January 2022 (UTC)

User:Samantha

2022-01-04T18:32:09Z

Snkennedy3327: Creating user page for new user.

I am the Office Manager at SAFE Project since February 2018.

User talk:Samantha

2022-01-04T18:32:09Z

Snkennedy3327: Welcome!

User:Mlabrie21

2021-09-23T02:32:37Z

Snkennedy3327: Creating user page for new user.

Director of Digital Communications at SAFE Project XX XX XX

User talk:Mlabrie21

2021-09-23T02:32:37Z

Snkennedy3327: Welcome!

User:G.Lehrman

2021-09-07T17:27:31Z

Snkennedy3327: Creating user page for new user.

Safe Project Intern & Student at George Washington University seeking degree in Public Health.

User talk:G.Lehrman

2021-09-07T17:27:31Z

Snkennedy3327: Welcome!

Expand Programs & Options for Chronic Pain Prevention

2021-06-28T22:35:17Z

Snkennedy3327:

<div class="wiki" id="content_view" style="display: block">
Return to [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom Map (Reduce Prescription of Opioids)]] Return to [[Health_Plans_and_Insurance_Companies|Partner Role - Health Plans]]   __TOC__

= Overview =

This objective focuses on taking proactive steps to prevent people from having chronic pain to begin with. If far fewer people were experiencing chronic pain, there would be far fewer people being prescribed opioids, and that would mean fewer chances for people to become dependent or develop and OUD. And, with fewer prescriptions, there would be fewer opioid pills in a community that might be diverted or misused.

= Promising Practices for Health Plans to Support Chronic Pain PREVENTION =
<div class="_">Health plans play an essential role in supporting improvements in chronic pain prevention because they determine what gets paid for. The following are recommended practices for Health Plans: </div>
 

== Add or expand coverage for chiropractic services for chronic pain prevention ==

Research shows that up to 80% of the population will experience back pain at some point during their lives.<ref>Rubin, D. I. (2007). Epidemiology and risk factors for spine pain. Neurologic Clinics, 25(2), 353–371. https://doi.org/10.1016/j.ncl.2007.01.004
</ref>   A recent global survey of health conditions identified back pain as the single most disabling condition worldwide.<ref>Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016—The Lancet. (n.d.). Retrieved November 24, 2019, from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32154-2/fulltext
</ref>

It is also the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections.<ref>Hart, L. G., Deyo, R. A., & Cherkin, D. C. (1995). Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine, 20(1), 11–19. https://doi.org/10.1097/00007632-199501000-00003
</ref>   American College of Physicians (ACP), the largest medical-specialty society in the world, updated its back pain treatment guidelines<ref>Machado, G. C., Maher, C. G., Ferreira, P. H., Day, R. O., Pinheiro, M. B., & Ferreira, M. L. (2017). Non-steroidal anti-inflammatory drugs for spinal pain: A systematic review and meta-analysis. Annals of the Rheumatic Diseases, 76(7), 1269–1278. https://doi.org/10.1136/annrheumdis-2016-210597
</ref> to support a conservative approach to care.  In March 2016, the Centers for Disease Control and Prevention released updated guidelines for prescribing opioids that also promote the use of non-pharmacologic alternatives for the treatment of chronic pain. In 2015, the Joint Commission, the organization that accredits more than 20,000 health care systems in the U.S. (including every major hospital), recognized the value of non-drug approaches to pain management by adding chiropractic and acupuncture to its pain management standard.<ref>Back Pain Prevention and Treatment, American Chiropractic Association, Retrieved from https://www.acatoday.org/Patients/Health-Wellness-Information/Back-Pain-Prevention

</ref> A study based on Washington state workers found that 42.7 percent of people who visited a surgeon first for work-related back pain eventually had surgery, compared to only 1.5 percent of those who visited a chiropractor first.[6] ( Missing Links here)   

Accelerating Physical Therapy Treatment of Low Back Pain to Avoid the Need to Prescribe Opioids

Back pain can worsen to a chronic condition if left untreated, which often leads to costly procedures and opioid dependency. In fact, lower back pain is one of the most common conditions treated with opioids. Bethlehem, Pa.-based St. Luke's University Health Network has a new Comprehensive Spine program (August 2018) to ensure patients with lower back pain get timely access to physical therapy services before the condition worsens and requires surgery or pain medications. St. Luke's program is designed to prevent the development of chronic back pain among patients by addressing the issue sooner with physical therapy.<ref>Back pain patients get fast therapy with St. Luke’s spine program. (2018, August 1). Retrieved November 24, 2019, from Modern Healthcare website: https://www.modernhealthcare.com/article/20180801/NEWS/180809988/back-pain-patients-get-fast-therapy-with-st-luke-s-spine-program</ref>

== Add or expend coverage for acupuncture services for chronic pain prevention ==

This would be for early treatment of pain-related conditions BEFORE they turns into chronic pain.  

== Add or expand coverage for health education or mindfulness as a way to prevent chronic pain ==

This should focus on health education and mindfulness as approaches to prevent the onset of chronic pain.  

== Train case managers in chronic pain prevention ==

This would involve early detection of symptoms or risk factors that, if left uncheck, would likely lead to chronic pain.  

== Support research on strategies for chronic pain prevention ==

Everyone wins with smart upstream prevention. Research is needed to guide investments in that type of prevention. Why wait until a person is dealing with chronic pain if it can be prevented.  
</div>
= Inspiring Examples of Chronic Pain PREVENTION =

 

== Add here ==

'''Tools & Resources''' [[TR_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|TR - Expand Programs & Options for Chronic Pain Prevention]]

= Scorecard Building =

[[PO_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|Potential Objective Details]] [[PM_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|Potential Measures and Data Sources]] [[PA_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|Potential Actions and Partners]]

= Resources to Investigate =

[[RTI_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|More RTI on Expand Programs & Options for Chronic Pain Prevention]] '''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

{| border="1" class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

 

= Sources =

 

  </div>

[[Category:SAFE-Prescriptions and Medical Response]]

Expand Programs & Options for Chronic Pain Prevention

2021-06-28T22:25:43Z

Snkennedy3327:

<div class="wiki" id="content_view" style="display: block">
Return to [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom Map (Reduce Prescription of Opioids)]] Return to [[Health_Plans_and_Insurance_Companies|Partner Role - Health Plans]]   __TOC__

= Overview =
This objective focuses on taking proactive steps to prevent people from having chronic pain to begin with. If far fewer people were experiencing chronic pain, there would be far fewer people being prescribed opioids, and that would mean fewer chances for people to become dependent or develop and OUD. And, with fewer prescriptions, there would be fewer opioid pills in a community that might be diverted or misused.
= Promising Practices for Health Plans to Support Chronic Pain PREVENTION =
<div class="_">Health plans play an essential role in supporting improvements in chronic pain prevention because they determine what gets paid for. The following are recommended practices for Health Plans: </div>
 

== Add or expand coverage for chiropractic services for chronic pain prevention ==

Research shows that up to 80% of the population will experience back pain at some point during their lives.<ref>Rubin, D. I. (2007). Epidemiology and risk factors for spine pain. Neurologic Clinics, 25(2), 353–371. https://doi.org/10.1016/j.ncl.2007.01.004
</ref>   A recent global survey of health conditions identified back pain as the single most disabling condition worldwide.<ref>Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016—The Lancet. (n.d.). Retrieved November 24, 2019, from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32154-2/fulltext
</ref>

It is also the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections.<ref>Hart, L. G., Deyo, R. A., & Cherkin, D. C. (1995). Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine, 20(1), 11–19. https://doi.org/10.1097/00007632-199501000-00003
</ref>   American College of Physicians (ACP), the largest medical-specialty society in the world, updated its back pain treatment guidelines<ref>[4]Machado, G. C., Maher, C. G., Ferreira, P. H., Day, R. O., Pinheiro, M. B., & Ferreira, M. L. (2017). Non-steroidal anti-inflammatory drugs for spinal pain: A systematic review and meta-analysis. Annals of the Rheumatic Diseases, 76(7), 1269–1278. https://doi.org/10.1136/annrheumdis-2016-210597
</ref> to support a conservative approach to care.  In March 2016, the Centers for Disease Control and Prevention released updated guidelines for prescribing opioids that also promote the use of non-pharmacologic alternatives for the treatment of chronic pain. In 2015, the Joint Commission, the organization that accredits more than 20,000 health care systems in the U.S. (including every major hospital), recognized the value of non-drug approaches to pain management by adding chiropractic and acupuncture to its pain management standard.<ref>Back Pain Prevention and Treatment, American Chiropractic Association, Retrieved from https://www.acatoday.org/Patients/Health-Wellness-Information/Back-Pain-Prevention

</ref> A study based on Washington state workers found that 42.7 percent of people who visited a surgeon first for work-related back pain eventually had surgery, compared to only 1.5 percent of those who visited a chiropractor first.[6] ( Missing Links here)   

Accelerating Physical Therapy Treatment of Low Back Pain to Avoid the Need to Prescribe Opioids

Back pain can worsen to a chronic condition if left untreated, which often leads to costly procedures and opioid dependency. In fact, lower back pain is one of the most common conditions treated with opioids. Bethlehem, Pa.-based St. Luke's University Health Network has a new Comprehensive Spine program (August 2018) to ensure patients with lower back pain get timely access to physical therapy services before the condition worsens and requires surgery or pain medications. St. Luke's program is designed to prevent the development of chronic back pain among patients by addressing the issue sooner with physical therapy.<ref>Back pain patients get fast therapy with St. Luke’s spine program. (2018, August 1). Retrieved November 24, 2019, from Modern Healthcare website: https://www.modernhealthcare.com/article/20180801/NEWS/180809988/back-pain-patients-get-fast-therapy-with-st-luke-s-spine-program</ref>

== Add or expend coverage for acupuncture services for chronic pain prevention ==

This would be for early treatment of pain-related conditions BEFORE they turns into chronic pain.  

== Add or expand coverage for health education or mindfulness as a way to prevent chronic pain ==

This should focus on health education and mindfulness as approaches to prevent the onset of chronic pain.  

== Train case managers in chronic pain prevention ==

This would involve early detection of symptoms or risk factors that, if left uncheck, would likely lead to chronic pain.  

== Support research on strategies for chronic pain prevention ==

Everyone wins with smart upstream prevention. Research is needed to guide investments in that type of prevention. Why wait until a person is dealing with chronic pain if it can be prevented.  
</div>
= Inspiring Examples of Chronic Pain PREVENTION =

 

== Add here ==

'''Tools & Resources''' [[TR_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|TR - Expand Programs & Options for Chronic Pain Prevention]]

= Scorecard Building =

[[PO_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|Potential Objective Details]] [[PM_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|Potential Measures and Data Sources]] [[PA_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|Potential Actions and Partners]]

= Resources to Investigate =

[[RTI_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|More RTI on Expand Programs & Options for Chronic Pain Prevention]] '''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

{| border="1" class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

 

= Sources =

 

 
</div>
[[Category:SAFE-Prescriptions and Medical Response]]

Expand Programs & Options for Chronic Pain Prevention

2021-06-28T22:24:39Z

Snkennedy3327:

<div class="wiki" id="content_view" style="display: block">
Return to [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom Map (Reduce Prescription of Opioids)]] Return to [[Health_Plans_and_Insurance_Companies|Partner Role - Health Plans]]   __TOC__

= Overview =
This objective focuses on taking proactive steps to prevent people from having chronic pain to begin with. If far fewer people were experiencing chronic pain, there would be far fewer people being prescribed opioids, and that would mean fewer chances for people to become dependent or develop and OUD. And, with fewer prescriptions, there would be fewer opioid pills in a community that might be diverted or misused. <div id="toc">
= Promising Practices for Health Plans to Support Chronic Pain PREVENTION =
<div class="_">Health plans play an essential role in supporting improvements in chronic pain prevention because they determine what gets paid for. The following are recommended practices for Health Plans: </div>
 

== Add or expand coverage for chiropractic services for chronic pain prevention ==

Research shows that up to 80% of the population will experience back pain at some point during their lives.<ref>Rubin, D. I. (2007). Epidemiology and risk factors for spine pain. Neurologic Clinics, 25(2), 353–371. https://doi.org/10.1016/j.ncl.2007.01.004
</ref>   A recent global survey of health conditions identified back pain as the single most disabling condition worldwide.<ref>Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016—The Lancet. (n.d.). Retrieved November 24, 2019, from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32154-2/fulltext
</ref>

It is also the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections.<ref>Hart, L. G., Deyo, R. A., & Cherkin, D. C. (1995). Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine, 20(1), 11–19. https://doi.org/10.1097/00007632-199501000-00003
</ref>   American College of Physicians (ACP), the largest medical-specialty society in the world, updated its back pain treatment guidelines<ref>[4]Machado, G. C., Maher, C. G., Ferreira, P. H., Day, R. O., Pinheiro, M. B., & Ferreira, M. L. (2017). Non-steroidal anti-inflammatory drugs for spinal pain: A systematic review and meta-analysis. Annals of the Rheumatic Diseases, 76(7), 1269–1278. https://doi.org/10.1136/annrheumdis-2016-210597
</ref> to support a conservative approach to care.  In March 2016, the Centers for Disease Control and Prevention released updated guidelines for prescribing opioids that also promote the use of non-pharmacologic alternatives for the treatment of chronic pain. In 2015, the Joint Commission, the organization that accredits more than 20,000 health care systems in the U.S. (including every major hospital), recognized the value of non-drug approaches to pain management by adding chiropractic and acupuncture to its pain management standard.<ref>Back Pain Prevention and Treatment, American Chiropractic Association, Retrieved from https://www.acatoday.org/Patients/Health-Wellness-Information/Back-Pain-Prevention

</ref> A study based on Washington state workers found that 42.7 percent of people who visited a surgeon first for work-related back pain eventually had surgery, compared to only 1.5 percent of those who visited a chiropractor first.[6] ( Missing Links here)   

Accelerating Physical Therapy Treatment of Low Back Pain to Avoid the Need to Prescribe Opioids

Back pain can worsen to a chronic condition if left untreated, which often leads to costly procedures and opioid dependency. In fact, lower back pain is one of the most common conditions treated with opioids. Bethlehem, Pa.-based St. Luke's University Health Network has a new Comprehensive Spine program (August 2018) to ensure patients with lower back pain get timely access to physical therapy services before the condition worsens and requires surgery or pain medications. St. Luke's program is designed to prevent the development of chronic back pain among patients by addressing the issue sooner with physical therapy.<ref>Back pain patients get fast therapy with St. Luke’s spine program. (2018, August 1). Retrieved November 24, 2019, from Modern Healthcare website: https://www.modernhealthcare.com/article/20180801/NEWS/180809988/back-pain-patients-get-fast-therapy-with-st-luke-s-spine-program</ref>

== Add or expend coverage for acupuncture services for chronic pain prevention ==

This would be for early treatment of pain-related conditions BEFORE they turns into chronic pain.  

== Add or expand coverage for health education or mindfulness as a way to prevent chronic pain ==

This should focus on health education and mindfulness as approaches to prevent the onset of chronic pain.  

== Train case managers in chronic pain prevention ==

This would involve early detection of symptoms or risk factors that, if left uncheck, would likely lead to chronic pain.  

== Support research on strategies for chronic pain prevention ==

Everyone wins with smart upstream prevention. Research is needed to guide investments in that type of prevention. Why wait until a person is dealing with chronic pain if it can be prevented.  
</div>
= Inspiring Examples of Chronic Pain PREVENTION =

 

== Add here ==

'''Tools & Resources''' [[TR_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|TR - Expand Programs & Options for Chronic Pain Prevention]]

= Scorecard Building =

[[PO_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|Potential Objective Details]] [[PM_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|Potential Measures and Data Sources]] [[PA_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|Potential Actions and Partners]]

= Resources to Investigate =

[[RTI_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|More RTI on Expand Programs & Options for Chronic Pain Prevention]] '''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

{| border="1" class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

 

= Sources =

 

 
</div>
[[Category:SAFE-Prescriptions and Medical Response]]

Expand Programs & Options for Chronic Pain Prevention

2021-06-28T22:22:47Z

Snkennedy3327:

<div class="wiki" id="content_view" style="display: block">
Return to [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom Map (Reduce Prescription of Opioids)]] Return to [[Health_Plans_and_Insurance_Companies|Partner Role - Health Plans]]   __TOC__

= Overview =
This objective focuses on taking proactive steps to prevent people from having chronic pain to begin with. If far fewer people were experiencing chronic pain, there would be far fewer people being prescribed opioids, and that would mean fewer chances for people to become dependent or develop and OUD. And, with fewer prescriptions, there would be fewer opioid pills in a community that might be diverted or misused. <div id="toc">
= Promising Practices for Health Plans to Support Chronic Pain PREVENTION =
Health plans play an essential role in supporting improvements in chronic pain prevention because they determine what gets paid for. The following are recommended practices for Health Plans:
 

== Add or expand coverage for chiropractic services for chronic pain prevention ==

Research shows that up to 80% of the population will experience back pain at some point during their lives.<ref>Rubin, D. I. (2007). Epidemiology and risk factors for spine pain. Neurologic Clinics, 25(2), 353–371. https://doi.org/10.1016/j.ncl.2007.01.004
</ref>   A recent global survey of health conditions identified back pain as the single most disabling condition worldwide.<ref>Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016—The Lancet. (n.d.). Retrieved November 24, 2019, from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32154-2/fulltext
</ref>

It is also the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections.<ref>Hart, L. G., Deyo, R. A., & Cherkin, D. C. (1995). Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine, 20(1), 11–19. https://doi.org/10.1097/00007632-199501000-00003
</ref>   American College of Physicians (ACP), the largest medical-specialty society in the world, updated its back pain treatment guidelines<ref>[4]Machado, G. C., Maher, C. G., Ferreira, P. H., Day, R. O., Pinheiro, M. B., & Ferreira, M. L. (2017). Non-steroidal anti-inflammatory drugs for spinal pain: A systematic review and meta-analysis. Annals of the Rheumatic Diseases, 76(7), 1269–1278. https://doi.org/10.1136/annrheumdis-2016-210597
</ref> to support a conservative approach to care.  In March 2016, the Centers for Disease Control and Prevention released updated guidelines for prescribing opioids that also promote the use of non-pharmacologic alternatives for the treatment of chronic pain. In 2015, the Joint Commission, the organization that accredits more than 20,000 health care systems in the U.S. (including every major hospital), recognized the value of non-drug approaches to pain management by adding chiropractic and acupuncture to its pain management standard.<ref>Back Pain Prevention and Treatment, American Chiropractic Association, Retrieved from https://www.acatoday.org/Patients/Health-Wellness-Information/Back-Pain-Prevention

</ref> A study based on Washington state workers found that 42.7 percent of people who visited a surgeon first for work-related back pain eventually had surgery, compared to only 1.5 percent of those who visited a chiropractor first.[6] ( Missing Links here)   

 

 

== Accelerating Physical Therapy Treatment of Low Back Pain to Avoid the Need to Prescribe Opioids ==

Back pain can worsen to a chronic condition if left untreated, which often leads to costly procedures and opioid dependency. In fact, lower back pain is one of the most common conditions treated with opioids. Bethlehem, Pa.-based St. Luke's University Health Network has a new Comprehensive Spine program (August 2018) to ensure patients with lower back pain get timely access to physical therapy services before the condition worsens and requires surgery or pain medications. St. Luke's program is designed to prevent the development of chronic back pain among patients by addressing the issue sooner with physical therapy.<ref>Back pain patients get fast therapy with St. Luke’s spine program. (2018, August 1). Retrieved November 24, 2019, from Modern Healthcare website: https://www.modernhealthcare.com/article/20180801/NEWS/180809988/back-pain-patients-get-fast-therapy-with-st-luke-s-spine-program</ref>

== Add or expend coverage for acupuncture services for chronic pain prevention ==

This would be for early treatment of pain-related conditions BEFORE they turns into chronic pain.  

== Add or expand coverage for health education or mindfulness as a way to prevent chronic pain ==

This should focus on health education and mindfulness as approaches to prevent the onset of chronic pain.  

== Train case managers in chronic pain prevention ==

This would involve early detection of symptoms or risk factors that, if left uncheck, would likely lead to chronic pain.  

== Support research on strategies for chronic pain prevention ==

Everyone wins with smart upstream prevention. Research is needed to guide investments in that type of prevention. Why wait until a person is dealing with chronic pain if it can be prevented.  
</div>
= Inspiring Examples of Chronic Pain PREVENTION =

 

== Add here ==

'''Tools & Resources''' [[TR_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|TR - Expand Programs & Options for Chronic Pain Prevention]]

= Scorecard Building =

[[PO_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|Potential Objective Details]] [[PM_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|Potential Measures and Data Sources]] [[PA_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|Potential Actions and Partners]]

= Resources to Investigate =

[[RTI_-_Expand_Programs_&_Options_for_Chronic_Pain_Prevention|More RTI on Expand Programs & Options for Chronic Pain Prevention]] '''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

 

= Sources =

 

 
</div>
[[Category:SAFE-Prescriptions and Medical Response]]

Expand Prescription Drug Take-back & Disposal Program

2021-06-28T22:17:04Z

Snkennedy3327:

''Return to [[ZOOM_MAP_-_Reduce_Diversion_of_Prescription_Drugs|Reduce Diversion of Prescription Drugs]]''

----

Most opioid abuse prevention strategies include some sort of prescription drug take-back or disposal program.  This is a step in the right direction, but most communities have significant opportunities to expand and enhance these efforts to reach more people and reduce the ability of people to misuse these medications or give them to others who may misuse them.  This objective focuses on practical ways to make improvements to existing efforts and to add new options that communities may not yet be doing. 

= Background =

== Why Safe Disposal is Important ==

'''Intentional Misuse''':

*A majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet.<ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ </ref>
*SAMHSA’s 2009 National Survey on Drug Use and Health found that over 70 percent of people who used prescription pain relievers non-medically got them from friends or relatives, while approximately 5 percent got them from a drug dealer or from the Internet.
*Getting hooked on prescription opioids is directly responsible for over 60% of subsequent heroin addictions as addicts turn to this less expensive alternative.
*Prescription drugs involved in overdoses are almost all originally prescribed by physicians but were used by others who were not prescribed those drugs. (Get sources for this.) 

'''Accidental Exposure''':

*When medicines are no longer needed or have expired, it is important to properly dispose of them to reduce harm from accidental exposure or intentional misuse.<ref>http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm</ref> Throwing drugs in the garbage also is a bad idea, because they can accidentally be taken by kids or pets.

'''Environmental Concerns''':

*Some people propose flushing or pouring unused medications down the drain, however medications flushed into the waste stream can end up in water supplies.<ref>http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts/</ref>
*Since the drugs in take-back programs are incinerated, take-back programs are the safest way to get rid of the chemicals and to stop them from getting into drinking water and watersheds as well as in the hands of those at risk.
*Innovative mail-back options provide a convenient way for people to have excess medications disposed of through incineration. (Details further down on this page.)

== Costs and Benefits of Safe Disposal Options ==

This fact sheet from the Product Stewardship Institute provides a good summary of the costs and benefits of different drug take-back and disposal options. 

[https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf]

== To Flush or Not to Flush ==

If no take-back programs are readily available, it is still important to dispose of the medications quickly and appropriately. Some prescriptions include instructions on how to dispose of the drug.<ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref> The [https://www.fda.gov U.S. Food & Drug Administration (FDA)] provides the safest ways of disposing of these medications at home [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm here]. The FDA also recommends that certain drugs be flushed immediately such as fentanyl patches, Oxycontin, and Percocet. A full list can be found on [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm#Flush_List this ]page.  Others experts strongly recommend '''not''' flushing medications down the toilet.<ref>Minnesota Pollution Control Agency https://www.pca.state.mn.us/featured/dont-flush-medicines-down-drain</ref>

The bottom line is that the best options are bringing your medications to a take-back day, putting them into a drug disposal kiosk, or using a mail-based program to send in the medications for proper disposal.  But, if you don't have access to these options, flushing unused medications that are on the "flush list" is better than keeping them around.   

= Special Populations =

== Senior Citizens ==

Senior citizens have a disproportionate number of medications in their homes. Helping seniors understand how to properly dispose of medications can make a big difference in the success of your program.  The Colorado Consortium for Prescription Drug Abuse Prevention has developed a successful program for reachng people age 65+ called "You're the Solution." This campaign has techniques and materials that can be used around the country. 

Learn more about [[You're_the_Solution|You're_the_Solution]] 

 

== Nursing Homes ==

Individual patients aside, one study estimated the nation’s nursing homes discard anywhere from $73 million to $378 million worth of drugs a year. Some are incinerated, but many are flushed.<ref>http://www.nbcnews.com/id/3077015/ns/health-health_care/t/got-old-medicine-dont-flush-it/#.XXVl6ehKhPZ</ref>  

Nursing homes could be provided with information and tools (or services) for more appropriate disposal options that are better for the environemnt and that minimize the likelihood of diversion of these medications.

== Hospice Programs or Funeral Home Programs ==

Hospice programs can help family members understand how to properly handle the medications they inherit when a loved one passes away.<ref>https://www.dea.gov/press-releases/2017/05/08/dea-brings-record-amount-unused-prescription-drugs-national-prescription</ref>

Funeral Homes may pass out a brochure to remind people to make sure that any prescription drugs that were being taken by a loved one are properly disposed of.  People in the late stages of life may have been getting prescription opioids to deal with pain.  Hospice and funeral homes could be provided with disposal products (like Seal&Send envelopes)

= Take-back Events =

== DEA National Drug Take-Back Day Initiative ==

The National Prescription Drug Take Back Day Initiative addresses a crucial public safety and public health issue by providing an opportunity for Americans to prevent drug addiction and overdose deaths. As of May 2017, the DEA has promoted 13 national take-back days and they continue to collect more and more drugs each time. <ref>https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0 </ref> '''[https://www.deadiversion.usdoj.gov/drug_disposal/takeback/newsrelease.htm Program Successes]'''

*Over 4,200 law enforcement and community partners and 5,500 sites across the country.
*Since September 2010, these events have altogether collected 8,103,363 pounds (4,052 tons) of prescription drugs.
*The last National Take-back Day collected more than 900,386 pounds (450 tons).

To promote your local Rx Take Back Day, the DEA provides a [https://www.dea.gov/take-back/takeback-day_2016_oct.html partnership toolkit] featuring promotional materials for associated partners.<ref>https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0</ref> '''See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more DEA take-back resources and other ideas on how to implement a local take-back day.'''

== State Level Drug Take Back Programs ==

See below for inspiration and ideas to replicate from current state efforts:

*[http://www.ddap.pa.gov/Prevention/Pages/Drug_Take_Back.aspx#.V07YY_krLcs Pennsylvania]
*[http://www.in.gov/bitterpill/ Indiana]
*[http://www.oregon.gov/oha/ph/HealthyEnvironments/DrinkingWater/SourceWater/Pages/takeback.aspx Oregon]
*[http://www.artakeback.org/index.html Arkansas]
*[http://www.takebackyourmeds.org/ Washington]
*[http://stoprxabuseinga.org/ Georgia]

= Local Disposal Drop Boxes =

== Finding Disposal Locations ==

=== Medication Disposal Locators ===

Use the following links to find drug disposal locations

*[https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1 DEA's Disposal Locator] - Find locations in your ZIP code. These collectors are registered with the DEA and pass unused medicine on to the agency to disposed.<ref>https://www.hometownsource.com/sun_focus/news/local/drop-off-prescription-drugs-anonymously-at-fridley-pd/article_b07bd27d-1122-55fa-8465-f47ad9a861dc.html</ref>
*[http://rxdrugdropbox.org/ Rx Drop Box]
*[http://disposemymeds.org/ Dispose My Meds]
*[https://nabp.pharmacy/initiatives/awarxe/drug-disposal-locator/ National Association of Boards of Pharmacy]
*[http://www.americanmedicinechest.com/ The American Medicine Chest Challenge]
*[https://walgreens.maps.arcgis.com/apps/MapSeries/index.html?appid=53cf1b54abf34c4bacdec863e5c56391 Walgreens Safe Medication Disposal Program]

== Increasing the Number of Drug Drop-Boxes in your Community ==

Since disposing of unneeded medications via a drug drop box is considered the best option, it is important for communities to increase the number of drop boxes that are available and to promote awareness of those drop boxes. 

Ths [https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/pharms_reports_factsheets/160920_PSI_Pharmacy_Guide_vS.pdf How-To Guide for Drug Take-Back] , created by the Product Stewardship Institute, provides detailed guidance for expanding and improving a pharmacy-based collection program. 

The [http://www.rxdrugdropbox.org/ NADDI prescription drug dropbox ] website is an important resource to find locations of drop boxes, buy boxes, apply for grants, and other information about drop boxes.

With the help of the of the [https://www.naddi.org/ National Association of Drug Diversion Investigators], communities can apply for grants to receive a drop box that will hold old opioids to prevent abuse. These boxes have resulted in multiple cities and communities to be safer, and reduce the risk of opioid addiction. Boxes are to be located in close proximity to law enforcement agencies so nothing happens to them. Multiple boxes have been placed in the State of Minnesota, and after reaching out to one town in specific, Fridley[11] , they told us that they have seen a positive response to the drop-box. They have discarded pounds of prescription opioids that came from an at-risk community.

= In-Home Disposal =

== Medication Mail-back Envelopes ==

'''Stericycle Prescription Drug Seal&Send Pouches'''

Stericyle provides an option for unsed prescription drugs to be mailed to them in an unmarked mailing pouch, and then the pills are incinerated. 

Learn more at: [https://www.stericycleenvironmental.com/service/pharmaceutical-takeback/ https://www.stericycleenvironmental.com/service/pharmaceutical-takeback/]

 

== In-home disposal pouches & powders ==

'''Deterra Drug Disposal System '''

Minneapolis based company Verde Technologies has created a product called [http://deterrasystem.com/ Deterra®] System which deactivates prescription drugs. Each patented Deterra® pouch contains a water-soluble inner pod containing MAT12® activated carbon. Once the pharmaceuticals are placed in the pouch, warm water is then added, which dissolves the inner pod releasing the activated carbon. The warm water also dissolves prescription pills, patches and liquids, allowing them to be adsorbed by the carbon, rendering them inert and non-retrievable. For more information on how to use Deterra®, view this [https://www.youtube.com/watch?v=lSBwBqpTk2c How-to video]  

'''Current Efforts to Promote In-Home Disposal'''
<div class="objectEmbed">Case Studies</div>
The state of Pennsylvania has a goal of distributing Deterra® Drug Deactivation and Disposal pouches alongside 10% of all opioid prescriptions.
<div class="objectEmbed">Attorney General Shapiro Unveils Plan to Distribute 300,000 Drug Disposal Pouches in 12 counties<ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref></div> <div class="objectEmbed">[https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html]</div>
Inspira Health Network (New Jersey) distributed the Deterra® pouch throughout their network. [http://www.njtvonline.org/news/video/inspira-health-network-battles-opioid-crisis-proper-drug-disposal/ Case Study] These pouches render opioids ineffective for misuse and safe for disposal and the environment, are another cost-efficient way to safely dispose of opioids.

'''Benefits'''

*Inexpensive - Costs $7 per pouch
*Can encourage people to connect with law enforcement - People can pick up free (if already given to law enforcement) pouches from station and dispose of them at home and save any potential embarrassment
*Improve overall water quality - with the majority of people flushing unused medication down the toilet, only water treatment facilities remove less than half of the prescription drugs found in sewage

'''DisposeRx'''

[http://disposerx.com/ Dispose Rx] is "a patented (pending) blend of solidifying materials that provides a solution for the safe disposal of unwanted or expired prescription drugs. Dedicated to environmentally friendly and safe non-toxic disposal solutions, DisposeRx is spearheading programs of educating communities with practical and safe medication disposing solutions, thus preventing the cycle of environmental pollution, addiction, overdose, and death." Prescription drugs can be rendered safe for disposal (and impossible to misuse) by adding powder from a packet directly into the pill bottle and shaking the bottle.

*Inexpensive - Costs about $1.50 per packet (and [https://www.aarp.org/health/drugs-supplements/info-2018/walmart-dispose-painkillers-fd.html Walmart gives the packets away free with a prescription or possibly a request])
*Packets can attached to prescriptions with a rubber band (much like flower fertilizer is attached to fresh-cut flowers)
*Well-suited to campaigns with community partners (like clinics, churches, barbershops or hair salons) to increase distribution to diverse populations.

See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more information.

 

= Funding for Drug Takeback & Disposal =

== Legislation & Drug Companies ==

Currently several West Coast counties, the city of San Francisco and the state of Massachusetts have issued legislature that require drug companies to fund drug take-back programs.<ref>[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/ </ref> On a national level, however, only 2.5 percent of eligible take-back organizations are participating, according to the Government Accountability Office. <ref>https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/</ref> The primary barrier seems to be financial: Maintaining the safe-like prescription drop-off container, training staff to follow the relevant regulations, and destroying the returned medication costs money. As a potential solution, writing policy that mandates opioid manufacturers to pay patients for their returned bottles of pills, along with subsidizing drop off location operators, could offset the costs and be what is needed to make returning leftover medication an automatic habit for consumers. <ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref> The [http://www.productstewardship.us/ Product Stewardship Institute], a nonprofit that supports drug take-back programs, calculated that at least a dozen other local governments around the country are considering similar legislation, including several California counties. In Minnesota, pharmaceutical company [http://www.mallinckrodt.com/ Mallinckrodt] donated 30,000 disposal pouch systems to be distributed.<ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref>

== State Legislation Requiring Disposal Kits be Given with Prescriptions ==

The Kentucky State Senate passed in March 2018 a bill that requires opioids and other abused drugs to be dispensed along with a method to permanently sequester and dispose of any leftover pills. If passed by the house and signed, it will be the first state passing such a bill.[4]  [http://www.disposerx.com DisposeRx] will be a popular choice to be given out along with prescription.  Other options include the Seal & Send mail-back packages or other options described below.

= Tools & Resources =

[[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|TR - Expand Prescription Drug Take-back & Disposal Programs]]

= Actions to Take =

There are many actions that can be taken by coalitions, organizations or individuals to improve drug take-back and disposal.  Explore the ideas via the following link: [[PA_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Coalitions]]

[[PAI_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Individuals]]

'''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
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|}

 

= Sources =

----

 

[[Category:Pages with broken file links]] [[Category:SAFE-Prescriptions and Medical Response]]

Expand Prescription Drug Take-back & Disposal Program

2021-06-28T22:16:01Z

Snkennedy3327:

''Return to [[ZOOM_MAP_-_Reduce_Diversion_of_Prescription_Drugs|Reduce Diversion of Prescription Drugs]]''

----

Most opioid abuse prevention strategies include some sort of prescription drug take-back or disposal program.  This is a step in the right direction, but most communities have significant opportunities to expand and enhance these efforts to reach more people and reduce the ability of people to misuse these medications or give them to others who may misuse them.  This objective focuses on practical ways to make improvements to existing efforts and to add new options that communities may not yet be doing. 

= Background =

== Why Safe Disposal is Important ==

'''Intentional Misuse''':

*A majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet.<ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ </ref>
*SAMHSA’s 2009 National Survey on Drug Use and Health found that over 70 percent of people who used prescription pain relievers non-medically got them from friends or relatives, while approximately 5 percent got them from a drug dealer or from the Internet.
*Getting hooked on prescription opioids is directly responsible for over 60% of subsequent heroin addictions as addicts turn to this less expensive alternative.
*Prescription drugs involved in overdoses are almost all originally prescribed by physicians but were used by others who were not prescribed those drugs. (Get sources for this.) 

'''Accidental Exposure''':

*When medicines are no longer needed or have expired, it is important to properly dispose of them to reduce harm from accidental exposure or intentional misuse.<ref>http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm</ref> Throwing drugs in the garbage also is a bad idea, because they can accidentally be taken by kids or pets.

'''Environmental Concerns''':

*Some people propose flushing or pouring unused medications down the drain, however medications flushed into the waste stream can end up in water supplies.<ref>http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts/</ref>
*Since the drugs in take-back programs are incinerated, take-back programs are the safest way to get rid of the chemicals and to stop them from getting into drinking water and watersheds as well as in the hands of those at risk.
*Innovative mail-back options provide a convenient way for people to have excess medications disposed of through incineration. (Details further down on this page.)

== Costs and Benefits of Safe Disposal Options ==

This fact sheet from the Product Stewardship Institute provides a good summary of the costs and benefits of different drug take-back and disposal options. 

[https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf]

== To Flush or Not to Flush ==

If no take-back programs are readily available, it is still important to dispose of the medications quickly and appropriately. Some prescriptions include instructions on how to dispose of the drug.<ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref> The [https://www.fda.gov U.S. Food & Drug Administration (FDA)] provides the safest ways of disposing of these medications at home [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm here]. The FDA also recommends that certain drugs be flushed immediately such as fentanyl patches, Oxycontin, and Percocet. A full list can be found on [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm#Flush_List this ]page.  Others experts strongly recommend '''not''' flushing medications down the toilet.<ref>Minnesota Pollution Control Agency https://www.pca.state.mn.us/featured/dont-flush-medicines-down-drain</ref>

The bottom line is that the best options are bringing your medications to a take-back day, putting them into a drug disposal kiosk, or using a mail-based program to send in the medications for proper disposal.  But, if you don't have access to these options, flushing unused medications that are on the "flush list" is better than keeping them around.   

= Special Populations =

== Senior Citizens ==

Senior citizens have a disproportionate number of medications in their homes. Helping seniors understand how to properly dispose of medications can make a big difference in the success of your program.  The Colorado Consortium for Prescription Drug Abuse Prevention has developed a successful program for reachng people age 65+ called "You're the Solution." This campaign has techniques and materials that can be used around the country. 

Learn more about [[You're_the_Solution|You're_the_Solution]] 

 

== Nursing Homes ==

Individual patients aside, one study estimated the nation’s nursing homes discard anywhere from $73 million to $378 million worth of drugs a year. Some are incinerated, but many are flushed.<ref>http://www.nbcnews.com/id/3077015/ns/health-health_care/t/got-old-medicine-dont-flush-it/#.XXVl6ehKhPZ</ref>  

Nursing homes could be provided with information and tools (or services) for more appropriate disposal options that are better for the environemnt and that minimize the likelihood of diversion of these medications.

== Hospice Programs or Funeral Home Programs ==

Hospice programs can help family members understand how to properly handle the medications they inherit when a loved one passes away.<ref>https://www.dea.gov/press-releases/2017/05/08/dea-brings-record-amount-unused-prescription-drugs-national-prescription</ref>

Funeral Homes may pass out a brochure to remind people to make sure that any prescription drugs that were being taken by a loved one are properly disposed of.  People in the late stages of life may have been getting prescription opioids to deal with pain.  Hospice and funeral homes could be provided with disposal products (like Seal&Send envelopes)

= Take-back Events =

== DEA National Drug Take-Back Day Initiative ==

The National Prescription Drug Take Back Day Initiative addresses a crucial public safety and public health issue by providing an opportunity for Americans to prevent drug addiction and overdose deaths. As of May 2017, the DEA has promoted 13 national take-back days and they continue to collect more and more drugs each time. <ref>https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0 </ref> '''[https://www.deadiversion.usdoj.gov/drug_disposal/takeback/newsrelease.htm Program Successes]'''

*Over 4,200 law enforcement and community partners and 5,500 sites across the country.
*Since September 2010, these events have altogether collected 8,103,363 pounds (4,052 tons) of prescription drugs.
*The last National Take-back Day collected more than 900,386 pounds (450 tons).

To promote your local Rx Take Back Day, the DEA provides a [https://www.dea.gov/take-back/takeback-day_2016_oct.html partnership toolkit] featuring promotional materials for associated partners.<ref>https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0</ref> '''See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more DEA take-back resources and other ideas on how to implement a local take-back day.'''

== State Level Drug Take Back Programs ==

See below for inspiration and ideas to replicate from current state efforts:

*[http://www.ddap.pa.gov/Prevention/Pages/Drug_Take_Back.aspx#.V07YY_krLcs Pennsylvania]
*[http://www.in.gov/bitterpill/ Indiana]
*[http://www.oregon.gov/oha/ph/HealthyEnvironments/DrinkingWater/SourceWater/Pages/takeback.aspx Oregon]
*[http://www.artakeback.org/index.html Arkansas]
*[http://www.takebackyourmeds.org/ Washington]
*[http://stoprxabuseinga.org/ Georgia]

= Local Disposal Drop Boxes =

== Finding Disposal Locations ==

=== Medication Disposal Locators ===

Use the following links to find drug disposal locations

*[https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1 DEA's Disposal Locator] - Find locations in your ZIP code. These collectors are registered with the DEA and pass unused medicine on to the agency to disposed.<ref>https://www.hometownsource.com/sun_focus/news/local/drop-off-prescription-drugs-anonymously-at-fridley-pd/article_b07bd27d-1122-55fa-8465-f47ad9a861dc.html</ref>
*[http://rxdrugdropbox.org/ Rx Drop Box]
*[http://disposemymeds.org/ Dispose My Meds]
*[https://nabp.pharmacy/initiatives/awarxe/drug-disposal-locator/ National Association of Boards of Pharmacy]
*[http://www.americanmedicinechest.com/ The American Medicine Chest Challenge]
*[https://walgreens.maps.arcgis.com/apps/MapSeries/index.html?appid=53cf1b54abf34c4bacdec863e5c56391 Walgreens Safe Medication Disposal Program]

== Increasing the Number of Drug Drop-Boxes in your Community ==

Since disposing of unneeded medications via a drug drop box is considered the best option, it is important for communities to increase the number of drop boxes that are available and to promote awareness of those drop boxes. 

Ths [https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/pharms_reports_factsheets/160920_PSI_Pharmacy_Guide_vS.pdf How-To Guide for Drug Take-Back] , created by the Product Stewardship Institute, provides detailed guidance for expanding and improving a pharmacy-based collection program. 

The [http://www.rxdrugdropbox.org/ NADDI prescription drug dropbox ] website is an important resource to find locations of drop boxes, buy boxes, apply for grants, and other information about drop boxes.

With the help of the of the [https://www.naddi.org/ National Association of Drug Diversion Investigators], communities can apply for grants to receive a drop box that will hold old opioids to prevent abuse. These boxes have resulted in multiple cities and communities to be safer, and reduce the risk of opioid addiction. Boxes are to be located in close proximity to law enforcement agencies so nothing happens to them. Multiple boxes have been placed in the State of Minnesota, and after reaching out to one town in specific, Fridley[11] , they told us that they have seen a positive response to the drop-box. They have discarded pounds of prescription opioids that came from an at-risk community.

= In-Home Disposal =

== Medication Mail-back Envelopes ==

'''Stericycle Prescription Drug Seal&Send Pouches'''

Stericyle provides an option for unsed prescription drugs to be mailed to them in an unmarked mailing pouch, and then the pills are incinerated. 

Learn more at: [https://www.stericycleenvironmental.com/service/pharmaceutical-takeback/ https://www.stericycleenvironmental.com/service/pharmaceutical-takeback/]

 

== In-home disposal pouches & powders ==

'''Deterra Drug Disposal System '''

Minneapolis based company Verde Technologies has created a product called [http://deterrasystem.com/ Deterra®] System which deactivates prescription drugs. Each patented Deterra® pouch contains a water-soluble inner pod containing MAT12® activated carbon. Once the pharmaceuticals are placed in the pouch, warm water is then added, which dissolves the inner pod releasing the activated carbon. The warm water also dissolves prescription pills, patches and liquids, allowing them to be adsorbed by the carbon, rendering them inert and non-retrievable. For more information on how to use Deterra®, view this [https://www.youtube.com/watch?v=lSBwBqpTk2c How-to video]  

'''Current Efforts to Promote In-Home Disposal'''
<div class="objectEmbed">Case Studies</div>
The state of Pennsylvania has a goal of distributing Deterra® Drug Deactivation and Disposal pouches alongside 10% of all opioid prescriptions.
<div class="objectEmbed">Attorney General Shapiro Unveils Plan to Distribute 300,000 Drug Disposal Pouches in 12 counties<ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref></div> <div class="objectEmbed">[https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html]</div>
Inspira Health Network (New Jersey) distributed the Deterra® pouch throughout their network. [http://www.njtvonline.org/news/video/inspira-health-network-battles-opioid-crisis-proper-drug-disposal/ Case Study] These pouches render opioids ineffective for misuse and safe for disposal and the environment, are another cost-efficient way to safely dispose of opioids.

'''Benefits'''

*Inexpensive - Costs $7 per pouch
*Can encourage people to connect with law enforcement - People can pick up free (if already given to law enforcement) pouches from station and dispose of them at home and save any potential embarrassment
*Improve overall water quality - with the majority of people flushing unused medication down the toilet, only water treatment facilities remove less than half of the prescription drugs found in sewage

'''DisposeRx'''

[http://disposerx.com/ Dispose Rx] is "a patented (pending) blend of solidifying materials that provides a solution for the safe disposal of unwanted or expired prescription drugs. Dedicated to environmentally friendly and safe non-toxic disposal solutions, DisposeRx is spearheading programs of educating communities with practical and safe medication disposing solutions, thus preventing the cycle of environmental pollution, addiction, overdose, and death." Prescription drugs can be rendered safe for disposal (and impossible to misuse) by adding powder from a packet directly into the pill bottle and shaking the bottle.

*Inexpensive - Costs about $1.50 per packet (and [https://www.aarp.org/health/drugs-supplements/info-2018/walmart-dispose-painkillers-fd.html Walmart gives the packets away free with a prescription or possibly a request])
*Packets can attached to prescriptions with a rubber band (much like flower fertilizer is attached to fresh-cut flowers)
*Well-suited to campaigns with community partners (like clinics, churches, barbershops or hair salons) to increase distribution to diverse populations.

See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more information.

 

= Funding for Drug Takeback & Disposal =

== Legislation & Drug Companies ==

Currently several West Coast counties, the city of San Francisco and the state of Massachusetts have issued legislature that require drug companies to fund drug take-back programs.<ref>[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/ </ref> On a national level, however, only 2.5 percent of eligible take-back organizations are participating, according to the Government Accountability Office. <ref>https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/</ref> The primary barrier seems to be financial: Maintaining the safe-like prescription drop-off container, training staff to follow the relevant regulations, and destroying the returned medication costs money. As a potential solution, writing policy that mandates opioid manufacturers to pay patients for their returned bottles of pills, along with subsidizing drop off location operators, could offset the costs and be what is needed to make returning leftover medication an automatic habit for consumers. <ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref> The [http://www.productstewardship.us/ Product Stewardship Institute], a nonprofit that supports drug take-back programs, calculated that at least a dozen other local governments around the country are considering similar legislation, including several California counties. In Minnesota, pharmaceutical company [http://www.mallinckrodt.com/ Mallinckrodt] donated 30,000 disposal pouch systems to be distributed.<ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref>

== State Legislation Requiring Disposal Kits be Given with Prescriptions ==

The Kentucky State Senate passed in March 2018 a bill that requires opioids and other abused drugs to be dispensed along with a method to permanently sequester and dispose of any leftover pills. If passed by the house and signed, it will be the first state passing such a bill.[4]  [http://www.disposerx.com DisposeRx] will be a popular choice to be given out along with prescription.  Other options include the Seal & Send mail-back packages or other options described below.

= Tools & Resources =

[[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|TR - Expand Prescription Drug Take-back & Disposal Programs]]

= Actions to Take =

There are many actions that can be taken by coalitions, organizations or individuals to improve drug take-back and disposal.  Explore the ideas via the following link: [[PA_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Coalitions]]

[[PAI_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Individuals]]

'''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

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= Sources =

 

----

 

#[http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm] [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm [1]]
#[http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/] [http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ [2]]
#[http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts/ http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts/] [http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts [3]]
#[http://disposerx.com/dl/Kentucky_Press_3-15_final.pdf [4]]
#[https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know] [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm [5]]
#[http://www.nbcnews.com/id/3077015/ns/health-health_care/t/got-old-medicine-dont-flush-it/#.XXVl6ehKhPZ http://www.nbcnews.com/id/3077015/ns/health-health_care/t/got-old-medicine-dont-flush-it/#.XXVl6ehKhPZ] [http://www.nbcnews.com/id/3077015/ns/health-health_care/t/got-old-medicine-dont-flush-it/#.WmEKDd-nGUk [6]]
#[https://www.dea.gov/press-releases/2017/05/08/dea-brings-record-amount-unused-prescription-drugs-national-prescription https://www.dea.gov/press-releases/2017/05/08/dea-brings-record-amount-unused-prescription-drugs-national-prescription] [https://www.dea.gov/divisions/hq/2017/hq050817a.shtml [7]
#[https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0 https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0] [https://www.dea.gov/divisions/hq/2015/hq100115.shtml [8]]
#[https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0 https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0] [https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm [9]]
#[https://www.hometownsource.com/sun_focus/news/local/drop-off-prescription-drugs-anonymously-at-fridley-pd/article_b07bd27d-1122-55fa-8465-f47ad9a861dc.html https://www.hometownsource.com/sun_focus/news/local/drop-off-prescription-drugs-anonymously-at-fridley-pd/article_b07bd27d-1122-55fa-8465-f47ad9a861dc.html]  [http://focus.mnsun.com/2013/02/19/drop-off-prescription-drugs-anonymously-at-fridley-pd/ [10]]
#[http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/] [http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ [11]]
#[https://fortune.com/2016/04/30/big-pharma-drug-take-back/ https://fortune.com/2016/04/30/big-pharma-drug-take-back/] [http://fortune.com/2016/04/30/big-pharma-drug-take-back/ [12]]
#[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/ https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/] [https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/?utm_term=.e9ccd1f56650 [13]]
#[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/ https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/][https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/?utm_term=.e9ccd1f56650 [14]]
#[http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/] [http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ [15]]

[[Category:Pages with broken file links]] [[Category:SAFE-Prescriptions and Medical Response]]

Expand ER & Healthcare Handoffs to Treatment

2021-06-28T21:36:20Z

Snkennedy3327:

Return to [[ZOOM_MAP_-_Improve_Treatment_&_Enable_Recovery_for_People_with_SUDs|ZOOM MAP - Improve Treatment & Enable Recovery for People with SUDs]]
  By systematically expanding processes for "warm handoffs" by Emergency Departments to treatment, recovery coaches and the other support needed by people who are misusing opioids, developing dependence or who have an SUD, many people will be more likely to get on the path for avoiding addiction or moving forward to long-term recovery.

= Background =

ER visits and hospitalizations due to opioid overdose is high and rising. "Overall, ED visits (reported by 52 jurisdictions in 45 states) for suspected opioid overdoses increased 30 percent in the U.S., from July 2016 through September 2017."<ref>Emergency Department Data Show Rapid Increases in Opioid Overdoses | CDC Online Newsroom | CDC. (2019, April 11). Retrieved December 5, 2019, from https://www.cdc.gov/media/releases/2018/p0306-vs-opioids-overdoses.html
</ref>

More than 140,000 people [https://www.cdc.gov/media/releases/2018/p0306-vs-opioids-overdoses.html visited an ER for overdoses] nationwide between July 2016 and Sept. 2017, according to the Centers for Disease Control and Prevention.<ref>How ER Docs Could Play A Key Role In Fighting The Opioid Epidemic | Center for Health Journalism. (n.d.). Retrieved December 5, 2019, from https://www.centerforhealthjournalism.org/fellowships/projects/how-er-docs-could-play-key-role-fighting-opioid-epidemic
</ref>

According to a May 2018 article, "Most ER doctors stabilize patients and release them with little or no attempt to offer long-term treatment."<ref>How ER Docs Could Play A Key Role In Fighting The Opioid Epidemic | Center for Health Journalism. (n.d.). Retrieved December 5, 2019, from https://www.centerforhealthjournalism.org/fellowships/projects/how-er-docs-could-play-key-role-fighting-opioid-epidemic
</ref>

“Research shows that people who have had an overdose are more likely to have another. Emergency department education and post-overdose protocols, including providing naloxone and linking people to treatment, are critical needs,” said Alana Vivolo-Kantor, Ph.D., behavioral scientist in CDC’s National Center for Injury Prevention and Control. “Data on opioid overdoses treated in emergency departments can inform timely, strategic, and coordinated response efforts in the community as well.”<ref>Emergency Department Data Show Rapid Increases in Opioid Overdoses | CDC Online Newsroom | CDC. (2019, April 11). Retrieved December 5, 2019, from https://www.cdc.gov/media/releases/2018/p0306-vs-opioids-overdoses.html</ref>

= Success Stories =

== Pioneering work in Rhode Island ==

The "warm handoff" model was pioneered in Rhode Island where all of the state’s emergency departments and hospitals were required to be state-certified to treat OUDs. The EDs must offer peer recovery support; prescribing the overdose reversal drug naloxone to at-risk patients; and offering MAT, including buprenorphine, in the ER or at a doctor’s office or treatment facility.  A study by Yale researchers found that opioid-addicted patients were more likely to get treatment and reduce opioid use long-term when started on medication-assisted treatment in the ER.[https://www.centerforhealthjournalism.org/fellowships/projects/how-er-docs-could-play-key-role-fighting-opioid-epidemic https://www.centerforhealthjournalism.org/fellowships/projects/how-er-docs-could-play-key-role-fighting-opioid-epidemic] 

 

= Tools & Resources =
<div class="_">TR - ___</div> <div class="_"> </div> <div class="_">This white paper from HealthLeaders magazine, [https://interactive.healthleadersmedia.com/Recovery_Begins_in_the_ED Recovery Begins in the ED], has good information. </div> <div class="_"> </div> <div class="_">This 2018 report in the Annals of Emergency Medicine provides valuable details: [https://www.annemergmed.com/article/S0196-0644(18)30079-9/fulltext Opportunities for Prevention and Intervention of Opioid Overdoses in the Emergency Department]  </div> <div class="_"> </div> <div class="_">This [https://emergency.cdc.gov/coca/calls/2018/callinfo_031318.asp webinar from March of 2018] goes into a lot of details on coordinating ER, Public Health and </div> <div class="_"> </div>
= Scorecard Building =

Potential Objective Details(Under Construction)  Potential Measures and Data Sources(Under Construction) 

= Actions to Take =

[[PA_-_Expand_ER_&_Healthcare_Handoffs_to_Treatment|Potential Actions and Partners]]
<div class="_"> </div>
= Resources to Investigate =
<div class="_">More RTI on __</div> <div class="_"> '''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]</div> <div class="_"> </div>
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[[Category:SAFE-Prescriptions and Medical Response]]

Expand Early Intervention in Communities for Substance Use Disorder

2021-06-28T21:33:52Z

Snkennedy3327:

''Return to [[Opioid_Top-Level_Strategy_Map|Top-Level Strategy Map]]''

----

<span id="docs-internal-guid-baf91879-7fff-d447-92b3-943abd0f34fa" style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">The goals of early intervention are to reduce the harms associated with substance use, to reduce risk behaviors before they lead to injury, to improve health and social function, and to prevent progression to a disorder and subsequent need for specialty substance use disorder services. Early intervention consists of providing information about substance use risks, normal or safe levels of use, and strategies to quit or cut down on use and use-related risk behaviors, and facilitating patient initiation and engagement in treatment when needed. Early intervention services may be considered the bridge between prevention and treatment services. For individuals with more serious substance misuse, intervention in these settings can serve as a mechanism to engage them into treatment.<ref name="Facing Addiction in America: The Surgeon General's Spotlight on Opioids">https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf</ref>

= Background =

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">The 2018 National Survey on Drug Use and Health<ref>https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf</ref><span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">reported on the continued use of substances across the U.S. 
<ul style="margin-top:0;margin-bottom:0;">
<li><span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">In 2018, approximately 20.3 million people aged 12 or older had a substance use disorder (SUD) related to their use of alcohol or illicit drugs in the past year, including 14.8 million people who had an alcohol use disorder and 8.1 million people who had an illicit drug use disorder. </li>
<li><span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">The most common illicit drug use disorder was marijuana use disorder (4.4 million people). An estimated 2.0 million 1.7 million people with a prescription pain reliever use disorder and 0.5 million people with a heroin use disorder.<ref>https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf</ref></li>
</ul>

== <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Goals of Early Intervention ==

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Early intervention reduces the harm associated with substance use, reduces risk behaviors before they lead to injury, improves health and social function, and prevents progression to a disorder and subsequent need for specialty substances use disorder services. Early intervention consists of providing information about substance use risks, normal or safe levels of use, and strategies to quit or cut down on use and use-related risk behaviors, and facilitating patient initiation and engagement in treatment when needed.  

== <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Prevention vs. Early Intervention ==

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Early intervention differs from Prevention efforts, especially when it comes to general and at-risk populations. <span style="font-size:10pt; font-family:Verdana; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Prevention targets the general population with a universal need to understand the risks of substance use disorder.  While Early Intervention efforts can also engage the general population, it focuses on age groups, individuals, or families at risk for particular disorders like substance use, or those who may have just started experimenting or using substances.

== <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Early Intervention in a Community Setting ==
<ul style="margin-top:0;margin-bottom:0;">
<li><span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Early intervention can be provided when an individual presents for another medical condition or social service need and is not seeking treatment for a substance use disorder.</li>
<li><span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Community intervention can involve multi-sector partnerships, community leaders and  members, and/or deliver services in community settings such as clinics, schools, jails, workplaces, emergency rooms, social services, senior citizen centers, or campuses.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440941/
</ref></li>
</ul>

== <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">At-Risk Populations Who Should Receive Early Intervention ==

<span style="font-size:10pt; font-family:Verdana; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">While the entire community can benefit from early intervention resources, there are populations that have been identified at a high risk for substance use.

*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Adolescents or adults at risk or who show signs of substance use or are experimenting with substances.
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Individuals who have suffered childhood trauma.<ref>https://www.acesconnection.com/
</ref>
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Binge drinkers: In 2018, about 139.8 million Americans aged 12 or older were past month alcohol users, 67.1 million were binge drinkers in the past month. About 2.2 million adolescents aged 12 to 17 drank alcohol in the past month, and 1.2 million of these adolescents binge drank in that period.<ref>https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf</ref>
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">People who use substances while driving.
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Expectant mothers who use substances while pregnant. 
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Senior citizens.
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Ethnic minorities who may not be receiving culturally relevant care
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Individuals with co-occurring substance use and mental disorders
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Homeless population.

== <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Components of Early Intervention: ==

*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Screening, Brief Intervention and Referral to Treatment, or SBIRT  <ref>http://ifi-wikis.com/IFI-OpioidCrisis/Expand_SBIRT_Program</ref>
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Screen for risk factors for substance use such as childhood trauma and ACEs<ref>https://www.acesconnection.com/</ref>
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Reduce Stigma in Community <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap"><ref>http://ifi-wikis.com/IFI-OpioidCrisis/Reduce_Stigma</ref>
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Pre-Arrest Diversion Programs <ref>https://ptaccollaborative.org/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf
</ref>
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">“Reachable Moments”,  such as providing patient education when prescribing opioids for chronic pain.<ref>https://news.ohsu.edu/2018/04/25/hospital-staff-experience-sea-change-in-addressing-substance-use-disorder</ref>
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Utilize Prescription Drug Monitoring Programs (PDMPs)<ref>https://www.asam.org/resources/publications/magazine/public-policy-statements/2018/04/24/prescription-drug-monitoring-programs-(pdmps)</ref> which are state-controlled electronic databases to track controlled substance prescriptions within a state. PDMPs  also provide prescribing and patient behavior information to prescribers and other authorities who are granted access to the information.

 

= Promising Programs =

== Project Engage - Delaware ==

<span id="docs-internal-guid-857cae61-7fff-0c74-fce2-ae34a5c60b91" style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Project Engage - Delaware<ref> https://christianacare.org/services/behavioralhealth/project-engage/
</ref>

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">ChristianaCare is a Delaware-based health system, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs.  Designed to help hospital patients who may be struggling with alcohol or drug use, Project Engage provides early intervention and referrals to substance use disorder treatment. Project Engage integrates peers in recovery, who are called engagement specialists, into the clinical setting in the hospital to meet with patients at their bedside about their alcohol or drug use. Project Engage collaborates with hospital staff to identify and connect patients with community-based substance use disorder treatment programs and other resources. Project Engage has also formed a partnership with the construction industry to offer recovery support to employees from participating construction companies.

== <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">OhioSTART (Sobriety, Treatment, and Reducing Trauma)<ref>https://ohiostart.org/ https://www.pcsao.org/programs/ohio-star
</ref> ==

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">The state of Ohio developed OhioSTART to help families dealing with substance use disorder avoid disruptive and costly out-of-home placements and helps keep families together. For parents who have lost custody of their children to foster care or another government-approved living arrangement,  the goal is to ultimately reunify and stabilize these families. The intervention program provides specialized victim services, such as intensive trauma counseling, to children who have suffered victimization with substance use of a parent being the primary risk factor. Additionally, the program assists those parents of those children with mentors who have firsthand experience with substance use disorder. 

== <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Project IMPACT, Portland, OR<ref>https://news.ohsu.edu/2018/04/25/hospital-staff-experience-sea-change-in-addressing-substance-use-disorder
</ref> ==

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Oregon Health and Science University (OHSU) and its partners conducted a needs assessment to map patient and system needs to critical intervention components and develop a business case. Using their findings, the group identified issues address in addiction treatment and intervention:

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">1. Hospitalization is a “reachable” moment: A survey of hospitalized adults conducted by OHSU revealed that 68% of high-risk drug users reported wanting to cut back or quit. Many patients also reported that they wanted to initiate medication-assisted treatment (MAT) while hospitalized, and that they wanted providers that understand addiction.

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">2. Lack of usual pathways to treatment: OHSU Hospital lacked established referral pathways to outpatient addiction care, and wait times were often long.  

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Their findings resulted in an innovative intervention program: Project IMPACT, or the Improving Addiction Care Team<span style="font-size:13.999999999999998pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">. <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">IMPACT includes two complementary components: First, an inpatient consult service giving patients a safe place to share their stories, while improving patient engagement and trust while expanding inpatient treatment options.  Second, partnerships with community providers to create rapid access pathways to treatment and create a smooth transition to MAT.

   

= Tools + Resources =

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">The Police, Treatment, and Community Collaborative (PTACC)<ref>https://ptaccollaborative.org/</ref> <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">is an alliance of practitioners in law enforcement, behavioral health, community, advocacy, research, and public policy, whose mission is to strategically widen community behavioral health and social service options available through law enforcement diversion. Their focus educates law enforcement and communities on pre-diversion for those who have committed nonviolent misdemeanors away from the criminal justice system and towards appropriate treatment or services can support these individuals, helping them avoid falling into the revolving door of the criminal justice system.  Pre-arrest diversion provides law enforcement with an effective alternative through referral to community-based intervention<span style="font-size:13pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">.<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap"><ref>https://ptaccollaborative.org/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref>

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Facing Addiction in America: The Surgeon General’s Spotlight on Opioids,<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">  “Importance  of Prevention, Screening, Early Intervention, and Treatment<ref>https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf</ref>

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">“Evidence-based interventions to prevent substance use, misuse and addiction target risk factors and enhance protective factors. Such interventions need to begin early in life to delay or prevent initiation of substance use and continue throughout the lifespan. For example, childhood trauma like adverse childhood experiences (ACEs) have been repeatedly linked to substance misuse. Primary prevention can also begin in the healthcare setting with prescribers using effective strategies to reduce overdoses involving prescription opioids such as safe prescribing practices. Currently, few primary care providers screen for or treat substance use disorders. Additionally, it is common for people who misuse opioids to misuse other substances or to have multiple substance use disorders, childhood trauma, or co-occurring physical and mental disorders. This highlights the need for full clinical assessment and comprehensive treatment services that are matched to an individual’s needs.”  

'''Community Catalyst: Expanding Substance Use Prevention and Early Intervention in Schools''':<ref>https://www.communitycatalyst.org/resources/tools/sbirt-resources</ref>  This online toolkit provides information and resources to mobilize communities to expand school-based services for substance use prevention and early intervention.  Other resources describe a key set of tools for SBIRT early intervention plus strategies to implement and fund this intervention in schools and clinics.

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Principles of Substance Abuse Prevention for Early Childhood, SAMHSA <ref>https://www.drugabuse.gov/publications/principles-substance-abuse-prevention-early-childhood/table-contents</ref>

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment, HHS Office of the Assistant Secretary for Planning and Evaluation, March 2019 <ref>https://aspe.hhs.gov/pdf-report/best-practices-and-barriers-engaging-people-substance-use-disorders-treatment</ref>

 

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= Sources =

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[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Prescriptions and Medical Response]]

Expand Early Intervention in Communities for Substance Use Disorder

2021-06-28T21:32:52Z

Snkennedy3327:

''Return to [[Opioid_Top-Level_Strategy_Map|Top-Level Strategy Map]]''

----

<span id="docs-internal-guid-baf91879-7fff-d447-92b3-943abd0f34fa" style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">The goals of early intervention are to reduce the harms associated with substance use, to reduce risk behaviors before they lead to injury, to improve health and social function, and to prevent progression to a disorder and subsequent need for specialty substance use disorder services. Early intervention consists of providing information about substance use risks, normal or safe levels of use, and strategies to quit or cut down on use and use-related risk behaviors, and facilitating patient initiation and engagement in treatment when needed. Early intervention services may be considered the bridge between prevention and treatment services. For individuals with more serious substance misuse, intervention in these settings can serve as a mechanism to engage them into treatment.<ref name="Facing Addiction in America: The Surgeon General's Spotlight on Opioids">https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf</ref>

= Background =

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">The 2018 National Survey on Drug Use and Health<ref>https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf</ref><span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">reported on the continued use of substances across the U.S. 
<ul style="margin-top:0;margin-bottom:0;">
<li><span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">In 2018, approximately 20.3 million people aged 12 or older had a substance use disorder (SUD) related to their use of alcohol or illicit drugs in the past year, including 14.8 million people who had an alcohol use disorder and 8.1 million people who had an illicit drug use disorder. </li>
<li><span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">The most common illicit drug use disorder was marijuana use disorder (4.4 million people). An estimated 2.0 million 1.7 million people with a prescription pain reliever use disorder and 0.5 million people with a heroin use disorder.<ref>https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf</ref></li>
</ul>

== <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Goals of Early Intervention ==

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Early intervention reduces the harm associated with substance use, reduces risk behaviors before they lead to injury, improves health and social function, and prevents progression to a disorder and subsequent need for specialty substances use disorder services. Early intervention consists of providing information about substance use risks, normal or safe levels of use, and strategies to quit or cut down on use and use-related risk behaviors, and facilitating patient initiation and engagement in treatment when needed.  

== <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Prevention vs. Early Intervention ==

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Early intervention differs from Prevention efforts, especially when it comes to general and at-risk populations. <span style="font-size:10pt; font-family:Verdana; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Prevention targets the general population with a universal need to understand the risks of substance use disorder.  While Early Intervention efforts can also engage the general population, it focuses on age groups, individuals, or families at risk for particular disorders like substance use, or those who may have just started experimenting or using substances.

== <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Early Intervention in a Community Setting ==
<ul style="margin-top:0;margin-bottom:0;">
<li><span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Early intervention can be provided when an individual presents for another medical condition or social service need and is not seeking treatment for a substance use disorder.</li>
<li><span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Community intervention can involve multi-sector partnerships, community leaders and  members, and/or deliver services in community settings such as clinics, schools, jails, workplaces, emergency rooms, social services, senior citizen centers, or campuses.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440941/
</ref></li>
</ul>

== <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">At-Risk Populations Who Should Receive Early Intervention ==

<span style="font-size:10pt; font-family:Verdana; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">While the entire community can benefit from early intervention resources, there are populations that have been identified at a high risk for substance use.

*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Adolescents or adults at risk or who show signs of substance use or are experimenting with substances.
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Individuals who have suffered childhood trauma.<ref>https://www.acesconnection.com/
</ref>
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Binge drinkers: In 2018, about 139.8 million Americans aged 12 or older were past month alcohol users, 67.1 million were binge drinkers in the past month. About 2.2 million adolescents aged 12 to 17 drank alcohol in the past month, and 1.2 million of these adolescents binge drank in that period.<ref>https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf</ref>
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">People who use substances while driving.
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Expectant mothers who use substances while pregnant. 
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Senior citizens.
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Ethnic minorities who may not be receiving culturally relevant care
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Individuals with co-occurring substance use and mental disorders
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Homeless population.

== <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Components of Early Intervention: ==

*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Screening, Brief Intervention and Referral to Treatment, or SBIRT  <ref>http://ifi-wikis.com/IFI-OpioidCrisis/Expand_SBIRT_Program</ref>
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Screen for risk factors for substance use such as childhood trauma and ACEs<ref>https://www.acesconnection.com/</ref>
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Reduce Stigma in Community <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap"><ref>http://ifi-wikis.com/IFI-OpioidCrisis/Reduce_Stigma</ref>
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Pre-Arrest Diversion Programs <ref>https://ptaccollaborative.org/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf
</ref>
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">“Reachable Moments”,  such as providing patient education when prescribing opioids for chronic pain.<ref>https://news.ohsu.edu/2018/04/25/hospital-staff-experience-sea-change-in-addressing-substance-use-disorder</ref>
*<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Utilize Prescription Drug Monitoring Programs (PDMPs)<ref>https://www.asam.org/resources/publications/magazine/public-policy-statements/2018/04/24/prescription-drug-monitoring-programs-(pdmps)</ref> which are state-controlled electronic databases to track controlled substance prescriptions within a state. PDMPs  also provide prescribing and patient behavior information to prescribers and other authorities who are granted access to the information.
 
= Promising Programs =

== Project Engage - Delaware ==

<span id="docs-internal-guid-857cae61-7fff-0c74-fce2-ae34a5c60b91" style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Project Engage - Delaware<ref> https://christianacare.org/services/behavioralhealth/project-engage/
</ref>

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">ChristianaCare is a Delaware-based health system, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs.  Designed to help hospital patients who may be struggling with alcohol or drug use, Project Engage provides early intervention and referrals to substance use disorder treatment. Project Engage integrates peers in recovery, who are called engagement specialists, into the clinical setting in the hospital to meet with patients at their bedside about their alcohol or drug use. Project Engage collaborates with hospital staff to identify and connect patients with community-based substance use disorder treatment programs and other resources. Project Engage has also formed a partnership with the construction industry to offer recovery support to employees from participating construction companies.

== <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">OhioSTART (Sobriety, Treatment, and Reducing Trauma)<ref>https://ohiostart.org/ https://www.pcsao.org/programs/ohio-star
</ref> ==

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">The state of Ohio developed OhioSTART to help families dealing with substance use disorder avoid disruptive and costly out-of-home placements and helps keep families together. For parents who have lost custody of their children to foster care or another government-approved living arrangement,  the goal is to ultimately reunify and stabilize these families. The intervention program provides specialized victim services, such as intensive trauma counseling, to children who have suffered victimization with substance use of a parent being the primary risk factor. Additionally, the program assists those parents of those children with mentors who have firsthand experience with substance use disorder. 

== <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Project IMPACT, Portland, OR<ref>https://news.ohsu.edu/2018/04/25/hospital-staff-experience-sea-change-in-addressing-substance-use-disorder
</ref> ==

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Oregon Health and Science University (OHSU) and its partners conducted a needs assessment to map patient and system needs to critical intervention components and develop a business case. Using their findings, the group identified issues address in addiction treatment and intervention:

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">1. Hospitalization is a “reachable” moment: A survey of hospitalized adults conducted by OHSU revealed that 68% of high-risk drug users reported wanting to cut back or quit. Many patients also reported that they wanted to initiate medication-assisted treatment (MAT) while hospitalized, and that they wanted providers that understand addiction.

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">2. Lack of usual pathways to treatment: OHSU Hospital lacked established referral pathways to outpatient addiction care, and wait times were often long.  

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Their findings resulted in an innovative intervention program: Project IMPACT, or the Improving Addiction Care Team<span style="font-size:13.999999999999998pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">. <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">IMPACT includes two complementary components: First, an inpatient consult service giving patients a safe place to share their stories, while improving patient engagement and trust while expanding inpatient treatment options.  Second, partnerships with community providers to create rapid access pathways to treatment and create a smooth transition to MAT.

 
 
= Tools + Resources =

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">The Police, Treatment, and Community Collaborative (PTACC)<ref>https://ptaccollaborative.org/</ref> <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">is an alliance of practitioners in law enforcement, behavioral health, community, advocacy, research, and public policy, whose mission is to strategically widen community behavioral health and social service options available through law enforcement diversion. Their focus educates law enforcement and communities on pre-diversion for those who have committed nonviolent misdemeanors away from the criminal justice system and towards appropriate treatment or services can support these individuals, helping them avoid falling into the revolving door of the criminal justice system.  Pre-arrest diversion provides law enforcement with an effective alternative through referral to community-based intervention<span style="font-size:13pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">.<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap"><ref>https://ptaccollaborative.org/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref>

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Facing Addiction in America: The Surgeon General’s Spotlight on Opioids,<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">  “Importance  of Prevention, Screening, Early Intervention, and Treatment<ref>https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf</ref>

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">“Evidence-based interventions to prevent substance use, misuse and addiction target risk factors and enhance protective factors. Such interventions need to begin early in life to delay or prevent initiation of substance use and continue throughout the lifespan. For example, childhood trauma like adverse childhood experiences (ACEs) have been repeatedly linked to substance misuse. Primary prevention can also begin in the healthcare setting with prescribers using effective strategies to reduce overdoses involving prescription opioids such as safe prescribing practices. Currently, few primary care providers screen for or treat substance use disorders. Additionally, it is common for people who misuse opioids to misuse other substances or to have multiple substance use disorders, childhood trauma, or co-occurring physical and mental disorders. This highlights the need for full clinical assessment and comprehensive treatment services that are matched to an individual’s needs.”  

'''Community Catalyst: Expanding Substance Use Prevention and Early Intervention in Schools''':<ref>https://www.communitycatalyst.org/resources/tools/sbirt-resources</ref>  This online toolkit provides information and resources to mobilize communities to expand school-based services for substance use prevention and early intervention.  Other resources describe a key set of tools for SBIRT early intervention plus strategies to implement and fund this intervention in schools and clinics.

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Principles of Substance Abuse Prevention for Early Childhood, SAMHSA <ref>https://www.drugabuse.gov/publications/principles-substance-abuse-prevention-early-childhood/table-contents</ref>

<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:700; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment, HHS Office of the Assistant Secretary for Planning and Evaluation, March 2019 <ref>https://aspe.hhs.gov/pdf-report/best-practices-and-barriers-engaging-people-substance-use-disorders-treatment</ref>
'''PAGE MANAGER:''' [insert name here]
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[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Prescriptions and Medical Response]]

Expand & Enhance Chronic Pain Prevention & Management

2021-06-28T20:37:11Z

Snkennedy3327:

<div class="wiki" id="content_view" style="display: block">
Return to the  [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom Map (Reduce Prescription of Opioids]]) __TOC__

= Background =

*Chronic pain occurs when pain last for longer than 3 months.<ref>[1] Pain Management: Treatment Overview. (n.d.). Retrieved November 24, 2019, from WebMD website: https://www.webmd.com/pain-management/guide/pain-management-treatment-overview
</ref>
*Pain affects more Americans than diabetes, heart disease and cancer combined.<ref>[2]Yesterday, Today & Tomorrow: NIH Research Timelines. (n.d.). Retrieved November 24, 2019, from https://archives.nih.gov/asites/report/09-09-2019/report.nih.gov/nihfactsheets/index.html
</ref>
*25.3 million American adults suffer from daily pain.<ref>Nahin, Richard L. “Estimates of Pain Prevalence and Severity in Adults: United States, 2012.” The journal of pain : official journal of the American Pain Society 16.8 (2015): 769–780. PMC. Web. 27 Jan. 2017</ref>
*23.4 million American adults report a lot of pain.<ref>Nahin, Richard L. “Estimates of Pain Prevalence and Severity in Adults: United States, 2012.” The journal of pain : official journal of the American Pain Society 16.8 (2015): 769–780. PMC. Web. 27 Jan. 2017.</ref>
*14.4 million American adults suffer the highest level of pain, category 4.<ref>Nahin, Richard L. “Estimates of Pain Prevalence and Severity in Adults: United States, 2012.” The journal of pain : official journal of the American Pain Society 16.8 (2015): 769–780. PMC. Web. 27 Jan. 2017</ref>
*Today, chronic pain is the most common cause of long-term disability in the U.S.<ref>[6]Yesterday, Today & Tomorrow: NIH Research Timelines. (n.d.). Retrieved November 24, 2019, from https://archives.nih.gov/asites/report/09-09-2019/report.nih.gov/nihfactsheets/index.html
</ref>

Chronic Pain and Opioid Use Among Seniors

Chronic pain is the primary reason seniors are prescribed opioids -- and use of opioids has many negatives for seniors (great article)<ref>[7] How the Opioid Crisis Affects the Elderly | Updated for 2019. (2018, September 4). Retrieved November 24, 2019, from AgingInPlace.org website: https://www.aginginplace.org/how-the-opioid-crisis-affects-the-elderly/
</ref>

== Risk factors ==

for chronic pain include:

 

*genetics - heritability accounts for 38.4% of the variation in chronic pain risk<ref>[8] Genetic and environmental risk factors for chronic pain. (n.d.). Retrieved November 24, 2019, from ScienceDaily website: https://www.sciencedaily.com/releases/2016/08/160816151850.htm
</ref>
*female gender<ref>O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123</ref>
*older age<ref>[9]Hecke, O. van, Torrance, N., & Smith, B. H. (2013). Chronic pain epidemiology and its clinical relevance. British Journal of Anaesthesia, 111(1), 13–18. https://doi.org/10.1093/bja/aet123
</ref>
*race and ethnicity<ref>[10Institute of Medicine (US) Committee on Advancing Pain Research, C. (2011). Pain as a Public Health Challenge. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK92516/</ref>
*being a military veteran<ref>[11]Institute of Medicine (US) Committee on Advancing Pain Research, C. (2011). Pain as a Public Health Challenge. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK92516/</ref>
*low socioeconomic status<ref>[12]O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123</ref>
*employment status and occupational factors<ref>[13]O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123</ref>
*history of abuse or interpersonal violence<ref>[14]O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123</ref>
*anxiety and depression<ref>[15]O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123</ref>
*existing health problems - fibromyalgia, shingles, arthritis, a weakened immune system<ref>[16]Pain Management: Treatment Overview. (n.d.). Retrieved November 24, 2019, from WebMD website: https://www.webmd.com/pain-management/guide/pain-management-treatment-overview
</ref>
*lifestyle - not eating health, not exercising regularly, smoking, or having a drug or alcohol problem<ref>[17]Pain Management: Treatment Overview. (n.d.). Retrieved November 24, 2019, from WebMD website: https://www.webmd.com/pain-management/guide/pain-management-treatment-overview
</ref>
*previous surgery<ref>[18]McGreevy, Kai, Michael M. Bottros, and Srinivasa N. Raja. “Preventing Chronic Pain Following Acute Pain: Risk Factors, Preventive Strategies, and Their Efficacy.” European journal of pain supplements 5.2 (2011): 365–372. PMC. Web. 27 Jan. 2017.
</ref>

 

== Managing Chronic Pain ==

*8 Million Americans are on long-term opioid therapy for chronic pain<ref>[19]Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet</ref>
*1 million are taking dangerously high doses<ref>[20]Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet</ref>
*The dilemma: how to provide the most effective pain treatment for 80 percent of pain patients who are at least risk for opioid addiction while causing the least harm to the remaining 20 percent who are at most risk of developing OUD<ref>[21]Genetic study defies “one-size-fits-all” approach to prescribing opioids for chronic pain. (n.d.). Retrieved November 24, 2019, from https://medicalxpress.com/news/2017-12-genetic-defies-one-size-fits-all-approach-opioids.html
</ref>
*Experts say chronic pain sufferers on high doses aren’t necessarily addicts, at least not the sort who would resort to buying drugs on the street<ref>[22]Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet
</ref>
*With most medical and government resources focused on treatment for more obvious drug abusers, few formal programs exist to help patients dependent on opioids<ref>[23]Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet</ref>
*Experts who have studied opioid dependence say that, in some cases, it’s too risky to reduce doses until complex psychological problems are under control<ref>[24]Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet</ref>

= Current Status =

Expanding and improving pain prevention programs is a hot topic among public health officials. In March 2016, the National Institute of Health released its National Pain Strategy that outlines the federal government's first coordinated plan to address America's pain crisis.<ref>[25]National Pain Strategy Overview | Interagency Pain Research Coordinating Committee. (n.d.). Retrieved November 24, 2019, from https://www.iprcc.nih.gov/National-Pain-Strategy/Overview</ref> One of the cornerstones of the strategy is the prevention of chronic pain.<ref>[26]National Pain Strategy Overview | Interagency Pain Research Coordinating Committee. (n.d.). Retrieved November 24, 2019, from https://www.iprcc.nih.gov/National-Pain-Strategy/Overview</ref>

= Promising Programs =

== Avoiding Illness and Injury ==

Workplace injury and illness prevention programs at both establishment and corporate levels are effective in transforming workplace culture; leading to reductions in injuries, illnesses and fatalities and lowering workers' compensation and other costs.<ref>[27]Injury and Illness Prevention Programs—Frequently Asked Questions. (n.d.). Retrieved November 24, 2019, from https://www.osha.gov/dsg/InjuryIllnessPreventionProgramsWhitePaper.html
</ref>  

Educational Programs

*Back Pain - Don't Take It Lying Down (Australia) - a 3 year campaign in Australia in the late 1990s that used mass media and other methods to promote several evidence-based concepts about back pain. <ref>[28]Buchbinder R. Can we change a population’s perspective on pain? In: Croft P, Blyth FM, van der Windt D, editors. Chronic pain epidemiology: From aetiology to public health. Oxford, England: Oxford University Press; 2010. pp. 329–344.</ref> 
**Outcome: "Dramatic improvements in what the public and clinicians believed about back pain, accompanied by a decline in related workers’ compensation claims and health care utilization during the campaign; those beliefs have persisted over time."<ref>[29]Institute of Medicine (US) Committee on Advancing Pain Research, C. (2011). Pain as a Public Health Challenge. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK92516/
</ref>

 

Pain Self Management Programs

[[MyStrength|myStrength]] is an example of a promising pain management program.  

== Private Facebook Group ==

Clare Rhodes runs a private Facebook group for chronic pain patients.<ref>[30]Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet
</ref>  

== The DiscovEHR Project ==

A researcher from Florida Atlantic University's Charles E. Schmidt College of Medicine has received a five-year, $4 million grant from the National Institutes of Health to help solve the "one-size-fits-all" approach to prescribing opioids for chronic pain. Because of the high heritability, finding the genetic predictors of prescription opioid use disorder is more critical than ever. Currently, little data exists on clinical characteristics and genetic variants that confer risk for opioid use disorder. In the novel study, researchers will assess clinical and genetic characteristics of a large patient cohort suffering from chronic musculoskeletal pain and receiving prescription opioids. As part of the project, researchers will leverage data from Geisinger's central biorepository and electronic health record (EHR) database to conduct large-scale genomics research and phenotype development. With the genetic information, the multidisciplinary team will derive a clinical and genetic profile of prescription opioid-use disorder and apply the knowledge to develop an "addiction risk score." Researchers hope the findings from this study will enable clinicians to identify those who are at low-risk for opioid use disorder from those who are at high-risk and require additional counseling and access to alternative treatment options. The genome-wide association study will help the researchers determine if there is a particular subset of genes and genetic variants that are influencing susceptibility to becoming addicted to prescription opioids. Once they are able to generate the hypothesis that a genetic variant is responsible for increasing risk, the next steps will involve proving causation. Ultimately, the researchers hope their work will be used to help empower patients so that they understand their susceptibility to risks and can make informed health care decisions.<ref> [31]Genetic study defies “one-size-fits-all” approach to prescribing opioids for chronic pain. (n.d.). Retrieved November 24, 2019, from https://medicalxpress.com/news/2017-12-genetic-defies-one-size-fits-all-approach-opioids.html
</ref>  

= Tools & Resources =

[[TR_-_Expand_&_Enhance_Chronic_Pain_Prevention_&_Management|TR - Expand & Enhance Chronic Pain Prevention]]

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[[Category:SAFE-Prescriptions and Medical Response]]

Reduce Theft of Pills from Pharmacies

2021-06-28T20:27:57Z

Snkennedy3327:

<div class="wiki" id="content_view" style="display: block">
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or [[ZOOM_MAP_-_Minimize_Diversion_of_Prescription_Drugs|Zoom Map (Minimize Diversion of Prescription Drugs)]])__TOC__

= Background =

*When considering overall store theft (employee and shoplifting), employee theft attributed to 44% of the total.<ref>https://www.pbahealth.com/10-tips-to-prevent-internal-theft-in-the-pharmacy/
</ref>

 

= Internal Theft =

== Identifying ==

[http://www.rxpatrol.com/ RxPatrol] a national database that tracks, analyzes and provides information on pharmacy crime, identified the following common scams committed by pharmacy employees.<ref>https://www.pbahealth.com/10-tips-to-prevent-internal-theft-in-the-pharmacy/</ref>

*Filling prescriptions for deceased patients
*Unauthorized early refills
*Filling fake written or called-in prescriptions
*Short filling prescriptions and pocketing medication
*Taking tablets from bottles, then replacing with “look alike” tablets
*Opening bottles or packages, removing tablets and then replacing and gluing the seal

 

== Prevention ==
<div class="_">Besides watching out for those common methods of theft by employees, here are 10 tips to help secure and protect your pharmacy from internal theft.<ref>https://www.pbahealth.com/10-tips-to-prevent-internal-theft-in-the-pharmacy/</ref>   1. Don’t allow all employees access to every area of the pharmacy. Limit access to the dispensing area based on need.   2. Don’t permit keys that unlock critical or sensitive areas to be taken off site. Stamp all keys with “Do Not Duplicate.”   3. Develop unique alarm codes for each authorized user.   4. Maintain an organized and clean workspace to reduce the opportunity for theft. Limit purses and bags allowed in the dispensing area.   5. Create separate key and alarm access codes.   6. Change alarm codes routinely.   7. Install CCTV cameras to deter employee theft. They also work as a robbery prevention measure.   8. Escort non-pharmacy staff at all times. (i.e. repairmen, contractors, family members)   9. When opening a new bottle of medication, always count the entire content of the bottle, even if only filling a small amount.   10. Waste and returns present an opportunity for internal theft. Implement strong controls such as witnessing all waste logging and securely storing waste, returns, and recalls until disposal.</div>
= Tools & Resources =

[[TR_-_Reduce_Theft_of_Pills_from_Pharmacies|TR - Reduce Theft of Pills from Pharmacies]]

= Scorecard Building =

[[PO_-_Reduce_Theft_of_Pills_from_Pharmacies|Potential Objective Details]] [[PM_-_Reduce_Theft_of_Pills_from_Pharmacies|Potential Measures and Data Sources]] [[PA_-_Reduce_Theft_of_Pills_from_Pharmacies|Potential Actions and Partners]]

= Resources to Investigate =

[[RTI_-_Reduce_Theft_of_Pills_from_Pharmacies|More RTI on Reduce Theft of Pills from Pharmacies]] '''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

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[[Category:SAFE-Law Enforcement and Criminal Justice]]

Reduce Access to Precursor Ingredients

2021-06-28T20:24:14Z

Snkennedy3327:

<div class="wiki" id="content_view" style="display: block">
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]or [[ZOOM_MAP_-_Minimize_Diversion_of_Prescription_Drugs|Zoom Map - (Minimize Diversion of Prescription Drugs)]]__TOC__

 

= Background =

 

= Programs =

== NPLEx ==
<div class="_">National Precursor Log Exchange (NPLEx) adopted by 33 states across the country, helps law enforcement in the fight against meth lab production by blocking unlawful purchases of medicine containing PSE at the pharmacy counter, in real-time, and across state lines. Across the country, over 44,000 retailers use the NPLEx system and some states have gone further and use NPLEx to ban the sale of any PSE products to those previously convicted of a meth crime.<ref>https://www.naddi.org/naddi-releases-2016-statistics-for-nplex-system/</ref> A similar system could be used for opioids.  </div> <div class="_"> </div>
= Tools & Resources =

[[TR_-_Reduce_Access_to_Precursor_Ingredients|TR - Reduce Access to Precursor Ingredients]]

= Scorecard Building =

[[PO_-_Reduce_Access_to_Precursor_Ingredients|Potential Objective Details]] [[PM_-_Reduce_Access_to_Precursor_Ingredients|Potential Measures and Data Sources]] [[PA_-_Reduce_Access_to_Precursor_Ingredients|Potential Actions and Partners]]

= Resources to Investigate =

[[RTI_-_Reduce_Access_to_Precursor_Ingredients|More RTI on Reduce Access to Precursor Ingredients]] '''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

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</div>
[[Category:SAFE-Law Enforcement and Criminal Justice]] [[Category:SAFE-Prescriptions and Medical Response]]

Expand the use of MAT in Correctional Facilities

2021-06-28T20:21:34Z

Snkennedy3327:

<div class="wiki" id="content_view" style="display: block">
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or [[ZOOM_MAP_-_Expand_Access_to_Optimized_MAT|the Zoom Map (Expand Access to Optimized MAT)]] 

= Current Status =

*65 percent of the nation’s 2.3 million inmates are addicted to drugs or alcohol
*Of the roughly 3,200 jails, 40 provide
*The biggest challenge is getting inmates to continue taking the medication once they leave the facility: "The physical symptoms of their addiction clear up pretty quickly and they feel like they’ve licked it, so they stop showing up for the monthly injections,” Klein said. “That’s when they tend to relapse.”
*161 jails (out of 3,200) in 27 states have MAT reentry programs
*Most common prison and jail MAT program model: Company that makes vivitrol provides it free to corrections for one use, most corrections give one dosage just before release as it is good for 28 days, this gives time to get plugged into community and treatment options

 

== Why MAT is Essential ==

*Majority of inmates who undergo treatment during incarceration don't make it follow-up treatment when released
*Half of inmates do not show for post-release treatment at least 2 times in 30 days; fewer than half complete aftercare program<ref>Justice Center, Access to Treatment, 2016</ref>
*Up to a third of those incarcerated are revoked probationers/parolees, disproportionately for treatment failures,, including positive urine samples<ref>Bureau of Justice Statistics, Revised January 21, 2015</ref>
*Death rate for those released with opioid use disorder within 24 days is more than 170 times that of the general population<ref>Binswanger, et al., 2007</ref>

 

== Best Practices for Treating Opioid Use Disorders ==

*Concurrent with treatment programs (6 months)
*Informed about all FDA approved medications (including adverse effects)
*Volunteer to participate
*Enroll in Medicaid or health insurance exchange before release
*Medical examination (liver test, drug test for 7-10

= Benefits =

* 

= Training =
<div class="_">Residential Substance Abuse Training RSAT training and technical assistance tool  </div> <div class="_">  other</div> <div class="_"> </div>
*Majority of inmates who undergo treatment during incarceration don't make it follow-up treatment when released
*Half of inmates do not show for post-release treatment at least 2 times in 30 days; fewer than half complete aftercare program<ref>Justice Center, Access to Treatment, 2016</ref>
*Up to a third of those incarcerated are revoked probationers/parolees, disproportionately for treatment failures,, including positive urine samples<ref>Bureau of Justice Statistics, Revised January 21, 2015</ref>
*Death rate for those released with opioid use disorder within 24 days is more than 170 times that of the general population<ref>Binswanger, et al., 2007 </ref>
* 

= Tools & Resources =

[[TR_-_Expand_the_use_of_MAT_in_Correctional_Facilities|TR - Expand the use of MAT in Correctional Facilities]]

 

[[RTI_-_Expand_the_use_of_MAT_in_Correctional_Facilities|More RTI on Expand the use of MAT in Correctional Facilities]] '''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

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[[Category:SAFE-Law Enforcement and Criminal Justice]] [[Category:SAFE-Treatment and Recovery]]

Enhance Treatment and Recovery Support During Incarceration

2021-06-28T20:11:35Z

Snkennedy3327:

<div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or [[ZOOM_MAP_-_Shift_from_Punishment_to_Treatment_Approach_for_Opioid_Users|Zoom Map - (Shift from Punishment to Treatment Approach for Opioid Users)]]  

= Overview =

Research has shown that a vast amount of the inmate population, on both the state and federal level, suffer from substance use disorder, a psychological disorder, or a combination of the two. Studies have shown that proper treatment during incarceration that is followed through to post release, significantly lowers their risk for relapse, criminality, inmate misconduct, and recidivism.

 

= Prison Treatment Programs =

The Criminal Justice System has supported treatment during incarceration by offering psychotherapy sessions, religious ministry meetings and 12-step programs such as Alcoholics Anonymous to inmates with substance use problems. <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

While there is significant need for more availability, federal prisons offer a number of programs designed to assist inmates in overcominig a substance use disorder such as:

*'''Drug Abuse Education'''
**Entails a series of classes that educate inmates on substance use disorder and the effects it has on your body and mind <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>
*'''Nonresidential Drug Abuse Treatment'''
**A12 week CBT (cognitive-behavioral therapy) program that is organized in group sessions
**This program addresses criminal lifestyles while also giving inmates the opportunity to increase skills in the areas of rational thinking, communication, and institution to community adjustment
**Inmates that are enrolled in this program normally have short sentences, do not meet the Residential Drug Abuse Program, are waiting to be enrolled in RDAP, are in transition back into the community or have a positive urinalysis test <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>
*'''Residential Drug Abuse Program (RDAP)'''
**The most intensive program that the Bureau provides
**Inmates in this program live in their own separate community from the rest of the population. Inmates take part in daily half-day programming and half-day of work, school, or vocational activities; this program is normally nine months in length
**Research shows inmates that take part in RDAP are less likely to recidivate and relapse to drug use by significant amounts compared to those inmates who do not take part in RDAP <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>
*'''Community Treatment Services (CTS)'''
**Provides continued care to inmates who have been released and put into Residential Reentry Centers or on Home Confinement
**Evidence shows that the period after being released is the most vulnerable time for inmates to relapse back to drug use or criminal activity; continued treatment after release is vital to the success of the offender completing their treatment <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

= Benefits of Successful Prison Treatment Programs =
<div>Well-designed prison treatment programs reduce relapse, criminality, inmate misconduct and recidivism — the likelihood that a convicted criminal will reoffend. They also increase levels of education, mend relationships, boost employment opportunities upon release and improve overall health. <ref>https://doi.org/10.1007/s11920-013-0414-z</ref></div> <div> </div> <div>Research shows that residential prison treatment is cost-effective if prisoners continue treatment after their release. The cost of treatment pales in comparison to the cost of incarceration. Rehab helps prisoners overcome drug use and reduces the economic burden of recidivism. <ref>https://doi.org/10.1007/s11920-013-0414-z</ref></div>
= Issues Affecting the Availability of Effective Treatment =

== Overcrowding of Jails and Prisons ==

Overcrowding of jails and prisons is a leading factor as to why inmates with drug dependency problems are not enrolled in these programs. The overcrowding of jails leads to an increase in the length of the waiting lists to enter drug treatment programs. In addition to overcrowding, staff shortages and limited resources are part of the issue of low enrollment in drug treatment programs.<ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

== Need for Trauma-Informed Care ==

Incarcerated prisoners are marked by considerable diversity, yet they share a common experience of incarceration. Prisons can be violent, harsh, psychologically damaging environments; incarcerated people live in an environment that is both depersonalizing and dehumanizing. Moreover, the social stigma associated with incarceration, combined with the depersonalizing effects of imprisonment, may result in a sense of hopelessness and powerlessness, as well as deeply internalized shame and guilt. Thus, in addition to treating substance abuse and other mental disorders, the consensus panel recommends that in-prison treatment also address the trauma of the incarceration itself as well as a prison culture that conflicts with treatment goals.<ref>https://www.ncbi.nlm.nih.gov/books/NBK64123/</ref>

= Training =

Residential Substance Abuse Training RSAT training and technical assistance tool

= Tools & Resources =

[[TR_-_Enhance_Treatment_During_Incarceration|TR - Enhance Treatment During Incarceration]]

 '''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =
</div> </div> </div> </div> </div> </div> </div> </div> </div>
[[Category:SAFE-Law Enforcement and Criminal Justice]]

Enhance Treatment and Recovery Support During Incarceration

2021-06-28T20:11:09Z

Snkennedy3327:

<div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or [[ZOOM_MAP_-_Shift_from_Punishment_to_Treatment_Approach_for_Opioid_Users|Zoom Map - (Shift from Punishment to Treatment Approach for Opioid Users)]]  

= Overview =

Research has shown that a vast amount of the inmate population, on both the state and federal level, suffer from substance use disorder, a psychological disorder, or a combination of the two. Studies have shown that proper treatment during incarceration that is followed through to post release, significantly lowers their risk for relapse, criminality, inmate misconduct, and recidivism.

 

= Prison Treatment Programs =

The Criminal Justice System has supported treatment during incarceration by offering psychotherapy sessions, religious ministry meetings and 12-step programs such as Alcoholics Anonymous to inmates with substance use problems. <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

While there is significant need for more availability, federal prisons offer a number of programs designed to assist inmates in overcominig a substance use disorder such as:

*'''Drug Abuse Education'''
**Entails a series of classes that educate inmates on substance use disorder and the effects it has on your body and mind <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>
*'''Nonresidential Drug Abuse Treatment'''
**A12 week CBT (cognitive-behavioral therapy) program that is organized in group sessions
**This program addresses criminal lifestyles while also giving inmates the opportunity to increase skills in the areas of rational thinking, communication, and institution to community adjustment
**Inmates that are enrolled in this program normally have short sentences, do not meet the Residential Drug Abuse Program, are waiting to be enrolled in RDAP, are in transition back into the community or have a positive urinalysis test <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>
*'''Residential Drug Abuse Program (RDAP)'''
**The most intensive program that the Bureau provides
**Inmates in this program live in their own separate community from the rest of the population. Inmates take part in daily half-day programming and half-day of work, school, or vocational activities; this program is normally nine months in length
**Research shows inmates that take part in RDAP are less likely to recidivate and relapse to drug use by significant amounts compared to those inmates who do not take part in RDAP <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>
*'''Community Treatment Services (CTS)'''
**Provides continued care to inmates who have been released and put into Residential Reentry Centers or on Home Confinement
**Evidence shows that the period after being released is the most vulnerable time for inmates to relapse back to drug use or criminal activity; continued treatment after release is vital to the success of the offender completing their treatment <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

= Benefits of Successful Prison Treatment Programs =
<div>Well-designed prison treatment programs reduce relapse, criminality, inmate misconduct and recidivism — the likelihood that a convicted criminal will reoffend. They also increase levels of education, mend relationships, boost employment opportunities upon release and improve overall health. <ref>https://doi.org/10.1007/s11920-013-0414-z</ref></div> <div> </div> <div>Research shows that residential prison treatment is cost-effective if prisoners continue treatment after their release. The cost of treatment pales in comparison to the cost of incarceration. Rehab helps prisoners overcome drug use and reduces the economic burden of recidivism. <ref>https://doi.org/10.1007/s11920-013-0414-z</ref></div>
= Issues Affecting the Availability of Effective Treatment =

== Overcrowding of Jails and Prisons ==

Overcrowding of jails and prisons is a leading factor as to why inmates with drug dependency problems are not enrolled in these programs. The overcrowding of jails leads to an increase in the length of the waiting lists to enter drug treatment programs. In addition to overcrowding, staff shortages and limited resources are part of the issue of low enrollment in drug treatment programs.<ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

== Need for Trauma-Informed Care ==

Incarcerated prisoners are marked by considerable diversity, yet they share a common experience of incarceration. Prisons can be violent, harsh, psychologically damaging environments; incarcerated people live in an environment that is both depersonalizing and dehumanizing. Moreover, the social stigma associated with incarceration, combined with the depersonalizing effects of imprisonment, may result in a sense of hopelessness and powerlessness, as well as deeply internalized shame and guilt. Thus, in addition to treating substance abuse and other mental disorders, the consensus panel recommends that in-prison treatment also address the trauma of the incarceration itself as well as a prison culture that conflicts with treatment goals.<ref>https://www.ncbi.nlm.nih.gov/books/NBK64123/</ref>

 

= Training =

Residential Substance Abuse Training RSAT training and technical assistance tool

= Tools & Resources =

[[TR_-_Enhance_Treatment_During_Incarceration|TR - Enhance Treatment During Incarceration]]

 '''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =
</div> </div> </div> </div> </div> </div> </div> </div> </div>
[[Category:SAFE-Law Enforcement and Criminal Justice]]

Disrupt the Supply of Illegal Drugs

2021-06-28T20:07:12Z

Snkennedy3327:

Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or [[ZOOM_MAP_-_Reduce_Access_to_Opioids|Zoom Map (Reduce Access to Opioids)]]
 

Add a intro paragraph here.  

= Background =

Key to any strategy to reduce opioid misuse is preventing illicit opioids, including heroin and synthetic opioids, from ever reaching communities. This role is almost exclusively the role and responsiblity of law enforcement at both the federal and state level, and requires cooperation between jurisdictions and federal partners to ensure success.

In the United States, fentanyl is classified as a Schedule II controlled substance, meaning there is a potential for misuse and dependence, but it does have an accepted medical use and can be prescribed for restricted use. Although prescribed synthetic opioids are sometimes diverted to the illicit market, the main reason for the surge in high purity synthetic opioids are from the increase in manufacturing from clandestine labs, which are either pressed into pills or left in powder form and mixed with heroin. <ref name="Drug Policy">https://drugpolicy.org/drug-facts/are-synthetic-opioids-legal</ref>

== Law Enforcement, State, and Federal Response ==

Increasing seizures of synthetic opioid-laced heroin by law enforcement, calls from politicians to increase punishment for possession and/or sale of illicit fentanyl included escalating mandatory minimum sentencing, and even capital punishment for sale of heroin.There is no evidence that escalating criminal punishment will have any effect on reducing risk of overdose or use in general. Research has suggested that these policies will fail to address the issues involving fentanyl and will continue the harmful trend of mass incarceration in the US. <ref name="Drug Policy">https://drugpolicy.org/drug-facts/are-synthetic-opioids-legal</ref>

 Individual states and the federal government’s efforts are centered around placing individual synthetic opioids and opiate-like NPS into Schedule I of the Controlled Substances Act (CSA). <ref name="Drug Policy">https://drugpolicy.org/drug-facts/are-synthetic-opioids-legal</ref>

== Perceived Dangers of Accidental Overdoses ==

With the distribution of [[Additional_Info_on_Fentanyl|fentanyl]], a powerful opioid that can be lethal in small amounts, overdoses have been reported by law enforment personnel as having occured through inhalation or absorption through the skin during routine encounters.<ref>http://www.cnn.com/2017/05/16/health/police-fentanyl-overdose-trnd/?iid=ob_article_footer_expansion]</ref> These instances, however, are more myth than reality,<ref>_</ref> and can lead to misplaced fear when law enforement and emergency responders come upon a suspected overdose. Any delay in responding to an overdose could cause brain damage and even death. See page on [[Support_Strategies_to_Address_Fentanyl|Support Strategies to Address Fentanyl]]

= National Programs =

== DEA 360 Strategy ==

'''Target Drug Trafficking Organizations''' In the past, the DEA has targeted low-level, first time non-violent offenders who usually are selling to get high themselves.<ref>http://www.wdrb.com/story/33150219/dea-announces-new-strategy-to-stop-drug-trafficking-drug-violence-and-drug-abuse</ref> This new strategy will target all drug deals, but start from the top down.<ref>http://www.wdrb.com/story/33150219/dea-announces-new-strategy-to-stop-drug-trafficking-drug-violence-and-drug-abuse</ref> "''These drug trafficking organizations are predators. There's no other way to describe it. They look for the vulnerable, they exploit them by finding them while they are trying to get treatment; that's how severe, how bad these drug trafficking organizations are to find their customer and peddle their poison. We're going to put together a task force and this task force is going to put together building federal cases based on these overdoses, and there is significant sentencing around and this is a way to impact straight into the organization and take out upper level members of an organization that directly impact the flow of drugs''.”<ref>http://www.wdrb.com/story/33150219/dea-announces-new-strategy-to-stop-drug-trafficking-drug-violence-and-drug-abuse</ref> -Thomas Gorman, Assistant Special Agent in Charge, DEA

== Organized Crime Drug Enforcement Task Force ==

'''Organized Crime Drug Enforcement Task Force (OCTDEF) National Heroin/Fentanyl and Opioid Initiative''' Since its inception in December of 2014, the ultimate goal of this initiative has been to develop multi-agency, multi-jurisdictional cases against criminal organizations. The Initiative leverages the national structure, resources and information sharing capabilities to identify the local street level distributors who are responsible for overdose deaths, as well as their network of suppliers at the local and regional level. In the last several years, OCDETF investigators and prosecutors attacked the opioid epidemic by prosecuting rogue physicians, pharmacists, internet sales, and pill mill operations. Their traditional diversion investigations involved overwriting of oxycodone by doctors, and misuse of fentanyl patches by users who clipped the edges to consume the gel inside. Today, OCTDEF funds 60 Heroin/Fentanyl and Opioid Initiatives across the country. <ref>https://www.justice.gov/usao/file/895091/download</ref> '''Working With China to Stop Export of Controlled Substances'''

*A large number of synthetic opioids, specifically fentanyl, come to the US from China. <ref>https://www.statnews.com/2016/09/03/us-china-fentanyl/</ref>
*China has agreed to crack down on the exports of substances that are controlled in the US, but not in China.<ref>https://www.statnews.com/2016/09/03/us-china-fentanyl/</ref>
*The US and China will work together to exchange more law enforcement and scientific information to coordinate actions.<ref>https://www.statnews.com/2016/09/03/us-china-fentanyl/</ref>
*Cooperation between the U.S. Drug Enforcement Agency (DEA) and the China Ministry of Public Security (MPS) and recognized China’s actions toward combating global synthetic drug trafficking.<ref>https://www.dea.gov/divisions/hq/2017/hq011317.shtml</ref>
*On October 1, 2015, China took an important step in international coordination by controlling a list of 116 synthetic drugs that were widely abused in the U.S.<ref>https://www.dea.gov/divisions/hq/2017/hq011317.shtml</ref>
*When evaluating a substance for control, the new provision also allows China to consider harm to the public in countries other than China.<ref>https://www.dea.gov/divisions/hq/2017/hq011317.shtml</ref>
*DEA continues to share information with Chinese officials to secure scheduling of additional fentanyl-class substances in China due to the wave of recent deaths in the United States from these synthetic opioids. <ref>https://www.dea.gov/divisions/hq/2017/hq011317.shtml</ref>
*At a time of massive growth in postal shipments from China due to e-commerce, the investigators found that the postal system received the electronic data on just over a third of all international packages, making more than 300 million packages in 2017 much harder to screen. Data in the Senate report shows no significant improvement during 2017 despite the urgency. <ref>[17]</ref>
*The U.S. Postal Service said it has made dramatic progress in the last year in total packages with opioids seized by U.S. Customs and Border Protection... implementing the use of electronic data is slowed by the need to negotiate with international partners, but the service is making progress. <ref>[18]</ref>

= General Strategies =

== Better Addiction Prevention, Treatment, and Recovery Services ==

Improve access to prevention, treatment, and recovery support services to prevent the health, social, and economic consequences associated with opioid misuse and addiction, and to enable individuals to achieve long-term recovery.<ref name="HHS">https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf</ref>

== Better Data ==

Strengthen public health data reporting and collection to improve the timeliness and specificity of data, and to inform a real-time public health response as the epidemic evolves.<ref name="HHS">https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf</ref>

== Better Pain Management ==

Advance the practice of pain management to enable access to high-quality, evidence-based pain care that reduces the burden of pain for individuals, families, and society while also reducing the inappropriate use of opioids and opioid-related harms.<ref name="HHS">https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf</ref>

== Better Targeting of Overdose Reversing Drugs ==

Target the availability and distribution of overdose-reversing medications to ensure the broad provision of these drugs to people likely to experience or respond to an overdose, with a particular focus on targeting high-risk populations.<ref name="HHS">https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf</ref>

== Better Research ==

Support cutting-edge research that advances our understanding of pain, overdose and addiction, leads to the development of new treatments, and identifies effective public health interventions to reduce opioid-related health harms.<ref name="HHS">https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf</ref>

= Tools & Resources =

[[TR_-_Expand_Efforts_to_Disrupt_the_Supply_of_Heroin_&_Synthetic_Opioids_to_the_Community|TR - Expand Efforts to Disrupt the Supply of Heroin & Synthetic Opioids to the Community]]

 '''PAGE MANAGER:''' [insert name here] '''SUBJECT MATTER EXPERT''': [fill out table below]

{| class="wiki_table"
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| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

----

 

[[Category:SAFE-Law Enforcement and Criminal Justice]]

Adopt Harm Reduction Practices in Jails and Prisons

2021-06-28T19:51:13Z

Snkennedy3327:

Adopt Harm Reduction Practices in Jails and Prisons

2021-06-28T19:50:44Z

Snkennedy3327:

Increase Access to Overdose Reversal Medications

2021-06-21T20:19:59Z

Snkennedy3327:

<div class="wiki" id="content_view" style="display: block">
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map or]] [[ZOOM_MAP_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]] or [[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|ZOOM MAP - Improve Access to Treatment that ]][[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|Prevent]][[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths| Overdose Deaths]]

= Overview =

[[Additional_Info_on_Naloxone|Naloxone]] (Narcan) is a prescription medicine that can reverse an opioid overdose or prevent it long enough for the person to receive adequate medical care. It blocks the opioid receptors in the brain to prevent an opioid user’s breathing and heart rates from slowing to fatal levels. Beginning in 2016, thirty-five states have made Narcan available to the general public as an over-the-counter drug to use as a nasal spray. Many other states are now working to pass laws that give police, first responders, and concerned family members the ability to carry and administer Narcan when called to a possible overdose situation. It is either injected or administered in a nasal spray. While [[Additional_Info_on_Naloxone|Naloxone]] is not readily available by ordinary citizens, it can be easily administered with little or no formal training. State laws have made it difficult for citizens to obtain the life-saving medication, due to third-party prescription and prescription via standing order policies. The third party-prescription law prohibits the prescription of drugs to a third party other than whom the drugs will be given to, while the standing order law prohibits the prescription of drugs to a person not personally examined by the prescribing physician. Although, the drug could potentially save more lives if more widely distributed, there is fear of bystanders not summoning medical assistance due to possible prosecution against them. According to a report by CADCA, a small community in Connecticut has made training for first responders to an overdose mandatory. Officers found a man in an unconscious state and realized he was overdosing. With the administration of Narcan, the man was able to recover from the overdose and regain consciousness. Narcan has the potential to be very beneficial in communities with a high opioid problem. Making a community aware of it's existence, and it's power to reverse overdose is a benefit unlike any other. Narcan will allow victims of abuse to be more likely to survive an overdose when first responders are rightly prepared. This medicine is one of need if a community is struggling with an opioid problem. It has been effective in saving lives, giving people with addiction a chance to realize the depth of their problem and a chance to ask for help.<ref>Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016.</ref>

= Key Information =

There is some evidence that opioid overdose education and naloxone distribution programs increase knowledge of appropriate overdose response among participating opioid users and others likely to encounter an overdose situation. Naloxone distribution through such programs is associated with reduced overdose deaths and appears to increase participant's confidence in their ability to respond effectively to overdose situations. However, additional evidence is needed to confirm effects.

Communities that implement programs to train potential bystanders to identify an opioid overdose and respond with naloxone appear to reduce opioid overdose death rates more than communities that do not implement such programs.

Family and friends of opioid users have greater knowledge of opioid overdose and ability to respond appropriately after receiving training in naloxone administration than peers who learn about opioid overdose and naloxone via na information booklet. Current or former opioid users who have received training in overdose response appear to identify overdose and recognize conditions when naloxone is appropriate as accurately as medical experts. Some studies suggest that opioid users who have participated in only a brief 5-10 minute training or learned naloxone administration through social networks can respond appropriately to an overdose.

Training first responders such as police, firefighters, and EMTs to administer naloxone may reduce time to overdose rescue, possibly decreasing overdose-related injury and death. Law enforcement officers who participate in naloxone administration and overdose training report increases in knowledge and confidence in managing opioid overdose emergencies after program completion.

= Relevant Research =

A recent study in Massachusetts found that cities that have naloxone distribution programs have [http://www.bmj.com/content/346/bmj.f174 lower overdose death] rates than those without a program. Similarly, the [http://www.nchrc.org/programs-and-services/ North Carolina Harm Reduction Coalition] has given out 52,000 naloxone kits since 2013 through their statewide grass roots network that includes syringe exchange and naloxone distribution, with more than 8,700 overdose reversals reported. [http://www.cadca.org/resources/coalition-action-meriden-healthy-youth-coalition-mhyc-provides-life-saving-overdose CADCA: Narcan Awareness ]<ref>CACDA Administration of Narcan. 2017 - http://www.cadca.org/resources/coalition-action-meriden-healthy-youth-coalition-mhyc-provides-life-saving-overdose
</ref>

== Educate about Dangers of Dual use ==

In 2013 there were 23,153 opioid overdose deaths -- 16,235 involving opioid painkillers, 8,260 involving heroin/opium, and at least 1,342 involving a combination of the two. However, opioid overdoses are seldom due to opioid use alone.  The majority of overdoses are a result of mixing an opioid with some other drug. The best way to avoid opioid overdose is not taking opioids and avoid knowingly mixing opiods with other drugs.  It is imperative tto understand the risk when opiods are mixed with other drugs and to take extra safety precautions when mixing drugs. These include:

*Don't use alone
*Limit the amount of drugs you have available
*Stick to less lethal combinations of drugs
*Use smaller amounts of each drug
*Use the least impairing drug first
*Have Narcan on hand
*When injecting drugs of unknown strength and purity (street heroin), start with a small "tester" shot to gauge the strength of the drug before injecting a full dose
*When using a drug or drug combination for the first time, start with a small dose to gauge your innate tolerance
*Make sure your friends (or at least someone) knows what drug combinations you have taken
*Have a plan in place in case something goes wrong

Narcan only works on opioids, but doesn't harm an individual in the case on non-opioid overdose. So if there's any question as to what a person took, use narcan; it can only help.<ref>http://www.rehabs.com/pro-talk-articles/the-ultimate-harm-reduction-guide-to-drug-mixing/</ref>

= Impactful Federal, State, and Local Policies =

== Good Samaritan Laws ==

People often hesitate to seek treatment or call medical assistance in fear of incarceration or other form of punishment. In August of 2015, the White House announced a treatment-based initiative with $2.5 million towards a pilot program that will engage law enforcement officers and public health professional to collect data on the movement of heroin along the East coast, and to train first responders on when it is adequate to administer Naloxone.<ref>http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html</ref>

In 2006, New Mexico passed a [http://www.nytimes.com/2007/04/05/us/05drugs.html "Good Samaritan Law"] that "granted limited immunity from prosecution on simple possession chargers for people who dialed 911 to report a drug overdose". By 2015, 28 states in addition to the District of Columbia had passed similar laws.

In Minnesota, a "Good Samaritan" law was passed to assure that people who call the police or emergency responders to help with an overdose situation will not face legal consequences for their involvement, use of, or possession of legal or illegal opioids. This removes a potential barrier--fear of arrest--that sometimes leads to help not being called and lives being lost to overdose.<ref>http://www.minnesotarecovery.org/files/FINAL_Good_Samaritan_Postcard.pdf</ref>

 [http://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx Drug Overdose Immunity and Good Samaritan Laws] for minimizing the fears of calling for help in the case of an overdose.

== Increasing Awareness of Law ==

*A University of Washington study evaluating the initial results of Washington state’s Good Samaritan policy found in a survey that drug users who were aware of the law were 88 percent more likely to call 911 in the event of an overdose than before.<ref>http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html</ref> [http://adai.uw.edu/pubs/infobriefs/ADAI-IB-2011-05.pdf University of Washington study]
*After New York state passed its Good Samaritan law in 2011, for example, the Drug Policy Alliance printed 1 million cards and posters that explained the law and offered basic instructions on how to initially respond to an overdose, and worked with various agencies to help distribute these materials to vulnerable populations.  

== Federal Changes to Address Problem ==

Various federal organizations came together to encourage good faith prescription of naloxone to ordinary citizens and the second was to encourage bystanders to become "Good Samaritans" by summoning emergency responders without fear of negative legal consequences.

== State Law Passage ==

By the end of 2016, all but 3 states, Kansas, Montana, and Wyoming, have passed laws to improve ordinary person naloxone access.

== Pharmacists ==

In California, The California State Board of Pharmacy passed a policy that allows pharmacists to give out Naloxone (Narcan) without a prescription in case of emergencies.<ref>http://www.pharmacy.ca.gov/publications/naloxone_media_release.pdf</ref>

== New in 2016: Improved Access to Nasal Narcan ==
New Public Interest Pricing $37.50 per dose <div class="objectEmbed">[[Media:Press_Release_for_Adapt_Pharma_and_Public_Interest_Pricing.pdf|Press Release for Adapt Pharma and Public Interest Pricing.pdf]]  (230 KB)</div> Free case of Narcan Nasal for any school. (Only 9 states allow as of Jan 2016). <div class="objectEmbed"><div>[[Media:Free_Narcan_Nasal_Spray_and_Education_for_High_Schools.pdf|Free Narcan Nasal Spray and Education for High Schools.pdf]]  (164 KB)</div> </div>
== Law Enforcement Use of Naloxone ==

*A 2016 report by the Police Executive Research Forum provides case examples of law enforcement naloxone programs instituted in Fayetteville (NC), Lummi Nation (WA), Virginia Beach (VA), Staten Island (NY), Camden County (CJ), Mongomery County (MD), and Hagerstown (MD) including descriptions of training, funding, administration and support.<ref>Police Executive Research Forum. 2016. Building Successful Partnerships between Law Enforcement and Public Health Agencies to Address Opioid Use. COPS Office Emerging Issues Forums. Washington, DC: Office of Community Oriented Policing Services.
https://ric-zai-inc.com/Publications/cops-p356-pub.pdf</ref>
*[[EI_-_Librarians_&_Access_to_Overdose_Treatment|EI - Librarians & Access to Overdose Treatment]] The Bureau of Justice Assistance (BJA) maintains an online toolkit featuring resources and information on naloxone, including a section on liability and risk for law enforcement officers and their employers associated with naloxone administration.<ref>https://www.bjatraining.org/tools/naloxone/Liability-and-Risk</ref>

== Database of State Legislative Efforts ==

The National Conference of State Legislatures [http://www.ncsl.org/research/health/prevention-of-prescription-drug-overdose-and-abuse.aspx site] has many examples of policy efforts that have been attempted or passed.

=== Prevent Overdose strategies ===

Thie overdoes and prevention strategies is a resource that has put every state's strategy into an online resource hub. This gives users a free resource to see what is being enacted in other states and lets people compare and contrast. This will allow for communities to enter and see what works and what does not.

 [https://www.overdosepreventionstrategies.org/ Overdose Prevention Strategies]

= Promising Practices =

[[CP_-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|CP - Improve Access to Treatments that Prevent Overdose Deaths]]

== Waive Copays ==

Many people who are prescribed Narcan (nearly 35%) don’t pick it up—presumably because they can’t afford the co-pay.<ref>https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/</ref> Having insurers eliminate the co-pay is one strategy to help address that. [https://www.aetna.com/index.html?cid=ppc-700000001035216-National_Always%20On_Branded_Aetna_Exact-Aetna-aetna&s_dfa=1&gclid=Cj0KCQiA38jRBRCQARIsACEqIeuilyQ_mSIjuCUt394XAuPY7X7VLnJ16hmHFgFYPcLvvOwo4NUwmxkaAsEhEALw_wcB&gclsrc=aw.ds Aetna] is currently the first national payer to waive copays for Narcan for its fully-insured commercial members. This will "increase access and remove possible financial barriers to the lifesaving drug."<ref>https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/</ref>

= Tools & Resources =

[[TR_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|TR - Improve Access to Treatment that Prevent Overdose Deaths]] [http:///file/view/SAMHSA_Opioid_Overdose_Prevention_TOOLKIT.pdf/613626145/SAMHSA_Opioid_Overdose_Prevention_TOOLKIT.pdf SAMHSA- Opioid Overdose Prevention Toolkit] - In particular, sections Facts for Community Members and Information for Prescribers may be of special interest.

== Actions to Take ==

[[PA_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|Actions for Coalitions]]

[[PAI_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|Actions for Individuals]]

= Sources =
</div>
[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Treatment and Recovery]]

Increase Access to Overdose Reversal Medications

2021-06-15T18:09:13Z

Snkennedy3327:

<div class="wiki" id="content_view" style="display: block">
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map or]] [[ZOOM_MAP_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]] or [[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|ZOOM MAP - Improve Access to Treatment that ]][[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|Prevent]][[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths| Overdose Deaths]]

= Overview =

[[Additional_Info_on_Naloxone|Naloxone]] (Narcan) is a prescription medicine that can reverse an opioid overdose or prevent it long enough for the person to receive adequate medical care. It blocks the opioid receptors in the brain to prevent an opioid user’s breathing and heart rates from slowing to fatal levels. Beginning in 2016, thirty-five states have made Narcan available to the general public as an over-the-counter drug to use as a nasal spray. Many other states are now working to pass laws that give police, first responders, and concerned family members the ability to carry and administer Narcan when called to a possible overdose situation. It is either injected or administered in a nasal spray. While [[Additional_Info_on_Naloxone|Naloxone]] is not readily available by ordinary citizens, it can be easily administered with little or no formal training. State laws have made it difficult for citizens to obtain the life-saving medication, due to third-party prescription and prescription via standing order policies. The third party-prescription law prohibits the prescription of drugs to a third party other than whom the drugs will be given to, while the standing order law prohibits the prescription of drugs to a person not personally examined by the prescribing physician. Although, the drug could potentially save more lives if more widely distributed, there is fear of bystanders not summoning medical assistance due to possible prosecution against them. According to a report by CADCA, a small community in Connecticut has made training for first responders to an overdose mandatory. Officers found a man in an unconscious state and realized he was overdosing. With the administration of Narcan, the man was able to recover from the overdose and regain consciousness. Narcan has the potential to be very beneficial in communities with a high opioid problem. Making a community aware of it's existence, and it's power to reverse overdose is a benefit unlike any other. Narcan will allow victims of abuse to be more likely to survive an overdose when first responders are rightly prepared. This medicine is one of need if a community is struggling with an opioid problem. It has been effective in saving lives, giving people with addiction a chance to realize the depth of their problem and a chance to ask for help.<ref>Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016.</ref>

= Key Information =

There is some evidence that opioid overdose education and naloxone distribution programs increase knowledge of appropriate overdose response among participating opioid users and others likely to encounter an overdose situation. Naloxone distribution through such programs is associated with reduced overdose deaths and appears to increase participant's confidence in their ability to respond effectively to overdose situations. However, additional evidence is needed to confirm effects.

Communities that implement programs to train potential bystanders to identify an opioid overdose and respond with naloxone appear to reduce opioid overdose death rates more than communities that do not implement such programs.

Family and friends of opioid users have greater knowledge of opioid overdose and ability to respond appropriately after receiving training in naloxone administration than peers who learn about opioid overdose and naloxone via na information booklet. Current or former opioid users who have received training in overdose response appear to identify overdose and recognize conditions when naloxone is appropriate as accurately as medical experts. Some studies suggest that opioid users who have participated in only a brief 5-10 minute training or learned naloxone administration through social networks can respond appropriately to an overdose.

Training first responders such as police, firefighters, and EMTs to administer naloxone may reduce time to overdose rescue, possibly decreasing overdose-related injury and death. Law enforcement officers who participate in naloxone administration and overdose training report increases in knowledge and confidence in managing opioid overdose emergencies after program completion.

= Relevant Research =

A recent study in Massachusetts found that cities that have naloxone distribution programs have [http://www.bmj.com/content/346/bmj.f174 lower overdose death] rates than those without a program. Similarly, the [http://www.nchrc.org/programs-and-services/ North Carolina Harm Reduction Coalition] has given out 52,000 naloxone kits since 2013 through their statewide grass roots network that includes syringe exchange and naloxone distribution, with more than 8,700 overdose reversals reported. [http://www.cadca.org/resources/coalition-action-meriden-healthy-youth-coalition-mhyc-provides-life-saving-overdose CADCA: Narcan Awareness ]<ref>CACDA Administration of Narcan. 2017 - http://www.cadca.org/resources/coalition-action-meriden-healthy-youth-coalition-mhyc-provides-life-saving-overdose
</ref>

== Educate about Dangers of Dual use ==

In 2013 there were 23,153 opioid overdose deaths -- 16,235 involving opioid painkillers, 8,260 involving heroin/opium, and at least 1,342 involving a combination of the two. However, opioid overdoses are seldom due to opioid use alone.  The majority of overdoses are a result of mixing an opioid with some other drug. The best way to avoid opioid overdose is not taking opioids and avoid knowingly mixing opiods with other drugs.  It is imperative tto understand the risk when opiods are mixed with other drugs and to take extra safety precautions when mixing drugs. These include:

*Don't use alone
*Limit the amount of drugs you have available
*Stick to less lethal combinations of drugs
*Use smaller amounts of each drug
*Use the least impairing drug first
*Have Narcan on hand
*When injecting drugs of unknown strength and purity (street heroin), start with a small "tester" shot to gauge the strength of the drug before injecting a full dose
*When using a drug or drug combination for the first time, start with a small dose to gauge your innate tolerance
*Make sure your friends (or at least someone) knows what drug combinations you have taken
*Have a plan in place in case something goes wrong

Narcan only works on opioids, but doesn't harm an individual in the case on non-opioid overdose. So if there's any question as to what a person took, use narcan; it can only help.<ref>http://www.rehabs.com/pro-talk-articles/the-ultimate-harm-reduction-guide-to-drug-mixing/</ref>

= Impactful Federal, State, and Local Policies =

== Good Samaritan Laws ==

People often hesitate to seek treatment or call medical assistance in fear of incarceration or other form of punishment. In August of 2015, the White House announced a treatment-based initiative with $2.5 million towards a pilot program that will engage law enforcement officers and public health professional to collect data on the movement of heroin along the East coast, and to train first responders on when it is adequate to administer Naloxone.[9]

In 2006, New Mexico passed a [http://www.nytimes.com/2007/04/05/us/05drugs.html "Good Samaritan Law"] that "granted limited immunity from prosecution on simple possession chargers for people who dialed 911 to report a drug overdose". By 2015, 28 states in addition to the District of Columbia had passed similar laws.

In Minnesota, a "Good Samaritan" law was passed to assure that people who call the police or emergency responders to help with an overdose situation will not face legal consequences for their involvement, use of, or possession of legal or illegal opioids. This removes a potential barrier--fear of arrest--that sometimes leads to help not being called and lives being lost to overdose.[10]

 [http://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx Drug Overdose Immunity and Good Samaritan Laws] for minimizing the fears of calling for help in the case of an overdose.

== Increasing Awareness of Law ==

*A University of Washington study evaluating the initial results of Washington state’s Good Samaritan policy found in a survey that drug users who were aware of the law were 88 percent more likely to call 911 in the event of an overdose than before.[11] [http://adai.uw.edu/pubs/infobriefs/ADAI-IB-2011-05.pdf University of Washington study]
*After New York state passed its Good Samaritan law in 2011, for example, the Drug Policy Alliance printed 1 million cards and posters that explained the law and offered basic instructions on how to initially respond to an overdose, and worked with various agencies to help distribute these materials to vulnerable populations.  

== Federal Changes to Address Problem ==

Various federal organizations came together to encourage good faith prescription of naloxone to ordinary citizens and the second was to encourage bystanders to become "Good Samaritans" by summoning emergency responders without fear of negative legal consequences.

== State Law Passage ==

By the end of 2016, all but 3 states, Kansas, Montana, and Wyoming, have passed laws to improve ordinary person naloxone access.

== Pharmacists ==

In California, The California State Board of Pharmacy passed a policy that allows pharmacists to give out Naloxone (Narcan) without a prescription in case of emergencies.[12]

== New in 2016: Improved Access to Nasal Narcan ==
New Public Interest Pricing $37.50 per dose <div class="objectEmbed">[[Media:Press_Release_for_Adapt_Pharma_and_Public_Interest_Pricing.pdf|Press Release for Adapt Pharma and Public Interest Pricing.pdf]]  (230 KB)</div> Free case of Narcan Nasal for any school. (Only 9 states allow as of Jan 2016). <div class="objectEmbed"><div>[[Media:Free_Narcan_Nasal_Spray_and_Education_for_High_Schools.pdf|Free Narcan Nasal Spray and Education for High Schools.pdf]]  (164 KB)</div> </div>
== Law Enforcement Use of Naloxone ==

*A 2016 report by the Police Executive Research Forum provides case examples of law enforcement naloxone programs instituted in Fayetteville (NC), Lummi Nation (WA), Virginia Beach (VA), Staten Island (NY), Camden County (CJ), Mongomery County (MD), and Hagerstown (MD) including descriptions of training, funding, administration and support.[13]
*[[EI_-_Librarians_&_Access_to_Overdose_Treatment|EI - Librarians & Access to Overdose Treatment]] The Bureau of Justice Assistance (BJA) maintains an online toolkit featuring resources and information on naloxone, including a section on liability and risk for law enforcement officers and their employers associated with naloxone administration.[14]

== Database of State Legislative Efforts ==

The National Conference of State Legislatures [http://www.ncsl.org/research/health/prevention-of-prescription-drug-overdose-and-abuse.aspx site] has many examples of policy efforts that have been attempted or passed.

=== Prevent Overdose strategies ===

Thie overdoes and prevention strategies is a resource that has put every state's strategy into an online resource hub. This gives users a free resource to see what is being enacted in other states and lets people compare and contrast. This will allow for communities to enter and see what works and what does not.

 [https://www.overdosepreventionstrategies.org/ Overdose Prevention Strategies]

= Promising Practices =

[[CP_-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|CP - Improve Access to Treatments that Prevent Overdose Deaths]]

== Waive Copays ==

Many people who are prescribed Narcan (nearly 35%) don’t pick it up—presumably because they can’t afford the co-pay.[7] Having insurers eliminate the co-pay is one strategy to help address that. [https://www.aetna.com/index.html?cid=ppc-700000001035216-National_Always%20On_Branded_Aetna_Exact-Aetna-aetna&s_dfa=1&gclid=Cj0KCQiA38jRBRCQARIsACEqIeuilyQ_mSIjuCUt394XAuPY7X7VLnJ16hmHFgFYPcLvvOwo4NUwmxkaAsEhEALw_wcB&gclsrc=aw.ds Aetna] is currently the first national payer to waive copays for Narcan for its fully-insured commercial members. This will "increase access and remove possible financial barriers to the lifesaving drug."[8]

= Tools & Resources =

[[TR_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|TR - Improve Access to Treatment that Prevent Overdose Deaths]] [http:///file/view/SAMHSA_Opioid_Overdose_Prevention_TOOLKIT.pdf/613626145/SAMHSA_Opioid_Overdose_Prevention_TOOLKIT.pdf SAMHSA- Opioid Overdose Prevention Toolkit] - In particular, sections Facts for Community Members and Information for Prescribers may be of special interest.

== Actions to Take ==

[[PA_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|Actions for Coalitions]]

[[PAI_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|Actions for Individuals]]

= Sources =

----

#Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016.
#CACDA Administration of Narcan. 2017  [http://www.cadca.org/resources/coalition-action-meriden-healthy-youth-coalition-mhyc-provides-life-saving-overdose [1]]
#100 Million Healthier Lives City, Town-Wide, and Regional Efforts.[https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_ https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_]
#100 Million Healthier Lives City, Town-Wide, and Regional Efforts [https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_ https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_]
#100 Million Healthier Lives City, Town-Wide, and Regional Efforts.[https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_ [2]]
#[http://www.rehabs.com/pro-talk-articles/the-ultimate-harm-reduction-guide-to-drug-mixing/ http://www.rehabs.com/pro-talk-articles/the-ultimate-harm-reduction-guide-to-drug-mixing/]
#[https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/ https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/]
#[https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/ https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/]
#[http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html]
#[http://www.minnesotarecovery.org/files/FINAL_Good_Samaritan_Postcard.pdf http://www.minnesotarecovery.org/files/FINAL_Good_Samaritan_Postcard.pdf]
#[http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html]
#[http://www.pharmacy.ca.gov/publications/naloxone_media_release.pdf http://www.pharmacy.ca.gov/publications/naloxone_media_release.pdf]
#Police Executive Research Forum. 2016. Building Successful Partnerships between Law Enforcement and Public Health Agencies to Address Opioid Use. COPS Office Emerging Issues Forums. Washington, DC: Office of Community Oriented Policing Services. [https://ric-zai-inc.com/Publications/cops-p356-pub.pdf https://ric-zai-inc.com/Publications/cops-p356-pub.pdf]
#[https://www.bjatraining.org/tools/naloxone/Liability-and-Risk https://www.bjatraining.org/tools/naloxone/Liability-and-Risk]
</div>
[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Treatment and Recovery]]

Prioritize SUD Treatment Over Incarceration

2021-06-08T21:32:11Z

Snkennedy3327:

Return to ...

----

Brief Description

= Introductory Paragraph =

Write a few sentences offering some introductory background information on this topic. The information here should be what you would want a reader to know about this topic and why it is important. This section should be high-level enough to provide an overview of the issue and/or strategy for professionals who may not be subject matter experts or well-versed on this topic.

= Key Information =

Please capture a deeper dive of the content in this section, to include any relevant subtopics or important things happening in the field the reader should be situationally aware of right now. You may have multiple paragraphs here with subtitles, if needed. While are not the experts and do not need to write out every detail about the subtopic like a research paper, we should make an attempt to fully capture the landscape of important things to know and link to any external information that may be helpful if the reader wants to learn more information.

= Relevant Research =

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

= Impactful Federal, State, and Local Policies =

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

= Available Tools and Resources =

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

= Promising Practices =

Please link to any best practice models or case studies that highlight creative/innovative or successful efforts in support of this strategy. Is there a community that does a really good job in this area that other communities should replicate? Please write a brief description and provide a link.

= Sources =

Increase Access to Overdose Reversal Medications

2021-05-26T21:43:13Z

Snkennedy3327:

<div class="wiki" id="content_view" style="display: block">
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map or]] [[ZOOM_MAP_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]] or [[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|ZOOM MAP - Improve Access to Treatment that ]][[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|Prevent]][[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths| Overdose Deaths]]

= Overview =

[[Additional_Info_on_Naloxone|Naloxone]] (Narcan) is a prescription medicine that can reverse an opioid overdose or prevent it long enough for the person to receive adequate medical care. It blocks the opioid receptors in the brain to prevent an opioid user’s breathing and heart rates from slowing to fatal levels. Beginning in 2016, thirty-five states have made Narcan available to the general public as an over-the-counter drug to use as a nasal spray. Many other states are now working to pass laws that give police, first responders, and concerned family members the ability to carry and administer Narcan when called to a possible overdose situation. It is either injected or administered in a nasal spray. While [[Additional_Info_on_Naloxone|Naloxone]] is not readily available by ordinary citizens, it can be easily administered with little or no formal training. State laws have made it difficult for citizens to obtain the life-saving medication, due to third-party prescription and prescription via standing order policies. The third party-prescription law prohibits the prescription of drugs to a third party other than whom the drugs will be given to, while the standing order law prohibits the prescription of drugs to a person not personally examined by the prescribing physician. Although, the drug could potentially save more lives if more widely distributed, there is fear of bystanders not summoning medical assistance due to possible prosecution against them. According to a report by CADCA, a small community in Connecticut has made training for first responders to an overdose mandatory. Officers found a man in an unconscious state and realized he was overdosing. With the administration of Narcan, the man was able to recover from the overdose and regain consciousness. Narcan has the potential to be very beneficial in communities with a high opioid problem. Making a community aware of it's existence, and it's power to reverse overdose is a benefit unlike any other. Narcan will allow victims of abuse to be more likely to survive an overdose when first responders are rightly prepared. This medicine is one of need if a community is struggling with an opioid problem. It has been effective in saving lives, giving people with addiction a chance to realize the depth of their problem and a chance to ask for help.<ref>Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016.</ref>

= Key Information =

There is some evidence that opioid overdose education and naloxone distribution programs increase knowledge of appropriate overdose response among participating opioid users and others likely to encounter an overdose situation. Naloxone distribution through such programs is associated with reduced overdose deaths and appears to increase participant's confidence in their ability to respond effectively to overdose situations. However, additional evidence is needed to confirm effects.

Communities that implement programs to train potential bystanders to identify an opioid overdose and respond with naloxone appear to reduce opioid overdose death rates more than communities that do not implement such programs.

Family and friends of opioid users have greater knowledge of opioid overdose and ability to respond appropriately after receiving training in naloxone administration than peers who learn about opioid overdose and naloxone via na information booklet. Current or former opioid users who have received training in overdose response appear to identify overdose and recognize conditions when naloxone is appropriate as accurately as medical experts. Some studies suggest that opioid users who have participated in only a brief 5-10 minute training or learned naloxone administration through social networks can respond appropriately to an overdose.

Training first responders such as police, firefighters, and EMTs to administer naloxone may reduce time to overdose rescue, possibly decreasing overdose-related injury and death. Law enforcement officers who participate in naloxone administration and overdose training report increases in knowledge and confidence in managing opioid overdose emergencies after program completion.

= Relevant Research =

A recent study in Massachusetts found that cities that have naloxone distribution programs have [http://www.bmj.com/content/346/bmj.f174 lower overdose death] rates than those without a program. Similarly, the [http://www.nchrc.org/programs-and-services/ North Carolina Harm Reduction Coalition] has given out 52,000 naloxone kits since 2013 through their statewide grass roots network that includes syringe exchange and naloxone distribution, with more than 8,700 overdose reversals reported. [http://www.cadca.org/resources/coalition-action-meriden-healthy-youth-coalition-mhyc-provides-life-saving-overdose CADCA: Narcan Awareness ]<ref>CACDA Administration of Narcan. 2017 - http://www.cadca.org/resources/coalition-action-meriden-healthy-youth-coalition-mhyc-provides-life-saving-overdose
</ref>

== Educate about Dangers of Dual use ==

In 2013 there were 23,153 opioid overdose deaths -- 16,235 involving opioid painkillers, 8,260 involving heroin/opium, and at least 1,342 involving a combination of the two. However, opioid overdoses are seldom due to opioid use alone.  The majority of overdoses are a result of mixing an opioid with some other drug. The best way to avoid opioid overdose is not taking opioids and avoid knowingly mixing opiods with other drugs.  It is imperative tto understand the risk when opiods are mixed with other drugs and to take extra safety precautions when mixing drugs. These include:

*Don't use alone
*Limit the amount of drugs you have available
*Stick to less lethal combinations of drugs
*Use smaller amounts of each drug
*Use the least impairing drug first
*Have Narcan on hand
*When injecting drugs of unknown strength and purity (street heroin), start with a small "tester" shot to gauge the strength of the drug before injecting a full dose
*When using a drug or drug combination for the first time, start with a small dose to gauge your innate tolerance
*Make sure your friends (or at least someone) knows what drug combinations you have taken
*Have a plan in place in case something goes wrong

Narcan only works on opioids, but doesn't harm an individual in the case on non-opioid overdose. So if there's any question as to what a person took, use narcan; it can only help.[6]

= Impactful Federal, State, and Local Policies =

== Good Samaritan Laws ==

People often hesitate to seek treatment or call medical assistance in fear of incarceration or other form of punishment. In August of 2015, the White House announced a treatment-based initiative with $2.5 million towards a pilot program that will engage law enforcement officers and public health professional to collect data on the movement of heroin along the East coast, and to train first responders on when it is adequate to administer Naloxone.[9]

In 2006, New Mexico passed a [http://www.nytimes.com/2007/04/05/us/05drugs.html "Good Samaritan Law"] that "granted limited immunity from prosecution on simple possession chargers for people who dialed 911 to report a drug overdose". By 2015, 28 states in addition to the District of Columbia had passed similar laws.

In Minnesota, a "Good Samaritan" law was passed to assure that people who call the police or emergency responders to help with an overdose situation will not face legal consequences for their involvement, use of, or possession of legal or illegal opioids. This removes a potential barrier--fear of arrest--that sometimes leads to help not being called and lives being lost to overdose.[10]

 [http://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx Drug Overdose Immunity and Good Samaritan Laws] for minimizing the fears of calling for help in the case of an overdose.

== Increasing Awareness of Law ==

*A University of Washington study evaluating the initial results of Washington state’s Good Samaritan policy found in a survey that drug users who were aware of the law were 88 percent more likely to call 911 in the event of an overdose than before.[11] [http://adai.uw.edu/pubs/infobriefs/ADAI-IB-2011-05.pdf University of Washington study]
*After New York state passed its Good Samaritan law in 2011, for example, the Drug Policy Alliance printed 1 million cards and posters that explained the law and offered basic instructions on how to initially respond to an overdose, and worked with various agencies to help distribute these materials to vulnerable populations.  

== Federal Changes to Address Problem ==

Various federal organizations came together to encourage good faith prescription of naloxone to ordinary citizens and the second was to encourage bystanders to become "Good Samaritans" by summoning emergency responders without fear of negative legal consequences.

== State Law Passage ==

By the end of 2016, all but 3 states, Kansas, Montana, and Wyoming, have passed laws to improve ordinary person naloxone access.

== Pharmacists ==

In California, The California State Board of Pharmacy passed a policy that allows pharmacists to give out Naloxone (Narcan) without a prescription in case of emergencies.[12]

== New in 2016: Improved Access to Nasal Narcan ==
New Public Interest Pricing $37.50 per dose <div class="objectEmbed">[[Media:Press_Release_for_Adapt_Pharma_and_Public_Interest_Pricing.pdf|Press Release for Adapt Pharma and Public Interest Pricing.pdf]]  (230 KB)</div> Free case of Narcan Nasal for any school. (Only 9 states allow as of Jan 2016). <div class="objectEmbed"><div>[[Media:Free_Narcan_Nasal_Spray_and_Education_for_High_Schools.pdf|Free Narcan Nasal Spray and Education for High Schools.pdf]]  (164 KB)</div> </div>
== Law Enforcement Use of Naloxone ==

*A 2016 report by the Police Executive Research Forum provides case examples of law enforcement naloxone programs instituted in Fayetteville (NC), Lummi Nation (WA), Virginia Beach (VA), Staten Island (NY), Camden County (CJ), Mongomery County (MD), and Hagerstown (MD) including descriptions of training, funding, administration and support.[13]
*[[EI_-_Librarians_&_Access_to_Overdose_Treatment|EI - Librarians & Access to Overdose Treatment]] The Bureau of Justice Assistance (BJA) maintains an online toolkit featuring resources and information on naloxone, including a section on liability and risk for law enforcement officers and their employers associated with naloxone administration.[14]

== Database of State Legislative Efforts ==

The National Conference of State Legislatures [http://www.ncsl.org/research/health/prevention-of-prescription-drug-overdose-and-abuse.aspx site] has many examples of policy efforts that have been attempted or passed.

=== Prevent Overdose strategies ===

Thie overdoes and prevention strategies is a resource that has put every state's strategy into an online resource hub. This gives users a free resource to see what is being enacted in other states and lets people compare and contrast. This will allow for communities to enter and see what works and what does not.

 [https://www.overdosepreventionstrategies.org/ Overdose Prevention Strategies]

= Promising Practices =

[[CP_-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|CP - Improve Access to Treatments that Prevent Overdose Deaths]]

== Waive Copays ==

Many people who are prescribed Narcan (nearly 35%) don’t pick it up—presumably because they can’t afford the co-pay.[7] Having insurers eliminate the co-pay is one strategy to help address that. [https://www.aetna.com/index.html?cid=ppc-700000001035216-National_Always%20On_Branded_Aetna_Exact-Aetna-aetna&s_dfa=1&gclid=Cj0KCQiA38jRBRCQARIsACEqIeuilyQ_mSIjuCUt394XAuPY7X7VLnJ16hmHFgFYPcLvvOwo4NUwmxkaAsEhEALw_wcB&gclsrc=aw.ds Aetna] is currently the first national payer to waive copays for Narcan for its fully-insured commercial members. This will "increase access and remove possible financial barriers to the lifesaving drug."[8]

= Tools & Resources =

[[TR_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|TR - Improve Access to Treatment that Prevent Overdose Deaths]] [http:///file/view/SAMHSA_Opioid_Overdose_Prevention_TOOLKIT.pdf/613626145/SAMHSA_Opioid_Overdose_Prevention_TOOLKIT.pdf SAMHSA- Opioid Overdose Prevention Toolkit] - In particular, sections Facts for Community Members and Information for Prescribers may be of special interest.

== Actions to Take ==

[[PA_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|Actions for Coalitions]]

[[PAI_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|Actions for Individuals]]

= Sources =

----

#Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016.
#CACDA Administration of Narcan. 2017  [http://www.cadca.org/resources/coalition-action-meriden-healthy-youth-coalition-mhyc-provides-life-saving-overdose [1]]
#100 Million Healthier Lives City, Town-Wide, and Regional Efforts.[https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_ https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_]
#100 Million Healthier Lives City, Town-Wide, and Regional Efforts [https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_ https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_]
#100 Million Healthier Lives City, Town-Wide, and Regional Efforts.[https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_ [2]]
#[http://www.rehabs.com/pro-talk-articles/the-ultimate-harm-reduction-guide-to-drug-mixing/ http://www.rehabs.com/pro-talk-articles/the-ultimate-harm-reduction-guide-to-drug-mixing/]
#[https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/ https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/]
#[https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/ https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/]
#[http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html]
#[http://www.minnesotarecovery.org/files/FINAL_Good_Samaritan_Postcard.pdf http://www.minnesotarecovery.org/files/FINAL_Good_Samaritan_Postcard.pdf]
#[http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html]
#[http://www.pharmacy.ca.gov/publications/naloxone_media_release.pdf http://www.pharmacy.ca.gov/publications/naloxone_media_release.pdf]
#Police Executive Research Forum. 2016. Building Successful Partnerships between Law Enforcement and Public Health Agencies to Address Opioid Use. COPS Office Emerging Issues Forums. Washington, DC: Office of Community Oriented Policing Services. [https://ric-zai-inc.com/Publications/cops-p356-pub.pdf https://ric-zai-inc.com/Publications/cops-p356-pub.pdf]
#[https://www.bjatraining.org/tools/naloxone/Liability-and-Risk https://www.bjatraining.org/tools/naloxone/Liability-and-Risk]
</div>
[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Treatment and Recovery]]

Increase Access to Overdose Reversal Medications

2021-05-26T21:40:33Z

Snkennedy3327:

<div class="wiki" id="content_view" style="display: block">
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map or]] [[ZOOM_MAP_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]] or [[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|ZOOM MAP - Improve Access to Treatment that ]][[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|Prevent]][[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths| Overdose Deaths]]

= Overview =

[[Additional_Info_on_Naloxone|Naloxone]] (Narcan) is a prescription medicine that can reverse an opioid overdose or prevent it long enough for the person to receive adequate medical care. It blocks the opioid receptors in the brain to prevent an opioid user’s breathing and heart rates from slowing to fatal levels. Beginning in 2016, thirty-five states have made Narcan available to the general public as an over-the-counter drug to use as a nasal spray. Many other states are now working to pass laws that give police, first responders, and concerned family members the ability to carry and administer Narcan when called to a possible overdose situation. It is either injected or administered in a nasal spray. While [[Additional_Info_on_Naloxone|Naloxone]] is not readily available by ordinary citizens, it can be easily administered with little or no formal training. State laws have made it difficult for citizens to obtain the life-saving medication, due to third-party prescription and prescription via standing order policies. The third party-prescription law prohibits the prescription of drugs to a third party other than whom the drugs will be given to, while the standing order law prohibits the prescription of drugs to a person not personally examined by the prescribing physician. Although, the drug could potentially save more lives if more widely distributed, there is fear of bystanders not summoning medical assistance due to possible prosecution against them. According to a report by CADCA, a small community in Connecticut has made training for first responders to an overdose mandatory. Officers found a man in an unconscious state and realized he was overdosing. With the administration of Narcan, the man was able to recover from the overdose and regain consciousness. Narcan has the potential to be very beneficial in communities with a high opioid problem. Making a community aware of it's existence, and it's power to reverse overdose is a benefit unlike any other. Narcan will allow victims of abuse to be more likely to survive an overdose when first responders are rightly prepared. This medicine is one of need if a community is struggling with an opioid problem. It has been effective in saving lives, giving people with addiction a chance to realize the depth of their problem and a chance to ask for help.<ref>Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016.</ref>

= Key Information =

There is some evidence that opioid overdose education and naloxone distribution programs increase knowledge of appropriate overdose response among participating opioid users and others likely to encounter an overdose situation. Naloxone distribution through such programs is associated with reduced overdose deaths and appears to increase participant's confidence in their ability to respond effectively to overdose situations. However, additional evidence is needed to confirm effects.

Communities that implement programs to train potential bystanders to identify an opioid overdose and respond with naloxone appear to reduce opioid overdose death rates more than communities that do not implement such programs.

Family and friends of opioid users have greater knowledge of opioid overdose and ability to respond appropriately after receiving training in naloxone administration than peers who learn about opioid overdose and naloxone via na information booklet. Current or former opioid users who have received training in overdose response appear to identify overdose and recognize conditions when naloxone is appropriate as accurately as medical experts. Some studies suggest that opioid users who have participated in only a brief 5-10 minute training or learned naloxone administration through social networks can respond appropriately to an overdose.

Training first responders such as police, firefighters, and EMTs to administer naloxone may reduce time to overdose rescue, possibly decreasing overdose-related injury and death. Law enforcement officers who participate in naloxone administration and overdose training report increases in knowledge and confidence in managing opioid overdose emergencies after program completion.

= Relevant Research =

A recent study in Massachusetts found that cities that have naloxone distribution programs have [http://www.bmj.com/content/346/bmj.f174 lower overdose death] rates than those without a program. Similarly, the [http://www.nchrc.org/programs-and-services/ North Carolina Harm Reduction Coalition] has given out 52,000 naloxone kits since 2013 through their statewide grass roots network that includes syringe exchange and naloxone distribution, with more than 8,700 overdose reversals reported. [http://www.cadca.org/resources/coalition-action-meriden-healthy-youth-coalition-mhyc-provides-life-saving-overdose CADCA: Narcan Awareness<ref>CACDA Administration of Narcan. 2017 - http://www.cadca.org/resources/coalition-action-meriden-healthy-youth-coalition-mhyc-provides-life-saving-overdose
</ref>]

== Educate about Dangers of Dual use ==

In 2013 there were 23,153 opioid overdose deaths -- 16,235 involving opioid painkillers, 8,260 involving heroin/opium, and at least 1,342 involving a combination of the two. However, opioid overdoses are seldom due to opioid use alone.  The majority of overdoses are a result of mixing an opioid with some other drug. The best way to avoid opioid overdose is not taking opioids and avoid knowingly mixing opiods with other drugs.  It is imperative tto understand the risk when opiods are mixed with other drugs and to take extra safety precautions when mixing drugs. These include:

*Don't use alone
*Limit the amount of drugs you have available
*Stick to less lethal combinations of drugs
*Use smaller amounts of each drug
*Use the least impairing drug first
*Have Narcan on hand
*When injecting drugs of unknown strength and purity (street heroin), start with a small "tester" shot to gauge the strength of the drug before injecting a full dose
*When using a drug or drug combination for the first time, start with a small dose to gauge your innate tolerance
*Make sure your friends (or at least someone) knows what drug combinations you have taken
*Have a plan in place in case something goes wrong

Narcan only works on opioids, but doesn't harm an individual in the case on non-opioid overdose. So if there's any question as to what a person took, use narcan; it can only help.[6]

= Impactful Federal, State, and Local Policies =

== Good Samaritan Laws ==

People often hesitate to seek treatment or call medical assistance in fear of incarceration or other form of punishment. In August of 2015, the White House announced a treatment-based initiative with $2.5 million towards a pilot program that will engage law enforcement officers and public health professional to collect data on the movement of heroin along the East coast, and to train first responders on when it is adequate to administer Naloxone.[9]

In 2006, New Mexico passed a [http://www.nytimes.com/2007/04/05/us/05drugs.html "Good Samaritan Law"] that "granted limited immunity from prosecution on simple possession chargers for people who dialed 911 to report a drug overdose". By 2015, 28 states in addition to the District of Columbia had passed similar laws.

In Minnesota, a "Good Samaritan" law was passed to assure that people who call the police or emergency responders to help with an overdose situation will not face legal consequences for their involvement, use of, or possession of legal or illegal opioids. This removes a potential barrier--fear of arrest--that sometimes leads to help not being called and lives being lost to overdose.[10]

 [http://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx Drug Overdose Immunity and Good Samaritan Laws] for minimizing the fears of calling for help in the case of an overdose.

== Increasing Awareness of Law ==

*A University of Washington study evaluating the initial results of Washington state’s Good Samaritan policy found in a survey that drug users who were aware of the law were 88 percent more likely to call 911 in the event of an overdose than before.[11] [http://adai.uw.edu/pubs/infobriefs/ADAI-IB-2011-05.pdf University of Washington study]
*After New York state passed its Good Samaritan law in 2011, for example, the Drug Policy Alliance printed 1 million cards and posters that explained the law and offered basic instructions on how to initially respond to an overdose, and worked with various agencies to help distribute these materials to vulnerable populations.  

== Federal Changes to Address Problem ==

Various federal organizations came together to encourage good faith prescription of naloxone to ordinary citizens and the second was to encourage bystanders to become "Good Samaritans" by summoning emergency responders without fear of negative legal consequences.

== State Law Passage ==

By the end of 2016, all but 3 states, Kansas, Montana, and Wyoming, have passed laws to improve ordinary person naloxone access.

== Pharmacists ==

In California, The California State Board of Pharmacy passed a policy that allows pharmacists to give out Naloxone (Narcan) without a prescription in case of emergencies.[12]

== New in 2016: Improved Access to Nasal Narcan ==
New Public Interest Pricing $37.50 per dose <div class="objectEmbed">[[Media:Press_Release_for_Adapt_Pharma_and_Public_Interest_Pricing.pdf|Press Release for Adapt Pharma and Public Interest Pricing.pdf]]  (230 KB)</div> Free case of Narcan Nasal for any school. (Only 9 states allow as of Jan 2016). <div class="objectEmbed"><div>[[Media:Free_Narcan_Nasal_Spray_and_Education_for_High_Schools.pdf|Free Narcan Nasal Spray and Education for High Schools.pdf]]  (164 KB)</div> </div>
== Law Enforcement Use of Naloxone ==

*A 2016 report by the Police Executive Research Forum provides case examples of law enforcement naloxone programs instituted in Fayetteville (NC), Lummi Nation (WA), Virginia Beach (VA), Staten Island (NY), Camden County (CJ), Mongomery County (MD), and Hagerstown (MD) including descriptions of training, funding, administration and support.[13]
*[[EI_-_Librarians_&_Access_to_Overdose_Treatment|EI - Librarians & Access to Overdose Treatment]] The Bureau of Justice Assistance (BJA) maintains an online toolkit featuring resources and information on naloxone, including a section on liability and risk for law enforcement officers and their employers associated with naloxone administration.[14]

== Database of State Legislative Efforts ==

The National Conference of State Legislatures [http://www.ncsl.org/research/health/prevention-of-prescription-drug-overdose-and-abuse.aspx site] has many examples of policy efforts that have been attempted or passed.

=== Prevent Overdose strategies ===

Thie overdoes and prevention strategies is a resource that has put every state's strategy into an online resource hub. This gives users a free resource to see what is being enacted in other states and lets people compare and contrast. This will allow for communities to enter and see what works and what does not.

 [https://www.overdosepreventionstrategies.org/ Overdose Prevention Strategies]

= Promising Practices =

[[CP_-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|CP - Improve Access to Treatments that Prevent Overdose Deaths]]

== Waive Copays ==

Many people who are prescribed Narcan (nearly 35%) don’t pick it up—presumably because they can’t afford the co-pay.[7] Having insurers eliminate the co-pay is one strategy to help address that. [https://www.aetna.com/index.html?cid=ppc-700000001035216-National_Always%20On_Branded_Aetna_Exact-Aetna-aetna&s_dfa=1&gclid=Cj0KCQiA38jRBRCQARIsACEqIeuilyQ_mSIjuCUt394XAuPY7X7VLnJ16hmHFgFYPcLvvOwo4NUwmxkaAsEhEALw_wcB&gclsrc=aw.ds Aetna] is currently the first national payer to waive copays for Narcan for its fully-insured commercial members. This will "increase access and remove possible financial barriers to the lifesaving drug."[8]

= Tools & Resources =

[[TR_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|TR - Improve Access to Treatment that Prevent Overdose Deaths]] [http:///file/view/SAMHSA_Opioid_Overdose_Prevention_TOOLKIT.pdf/613626145/SAMHSA_Opioid_Overdose_Prevention_TOOLKIT.pdf SAMHSA- Opioid Overdose Prevention Toolkit] - In particular, sections Facts for Community Members and Information for Prescribers may be of special interest.

== Actions to Take ==

[[PA_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|Actions for Coalitions]]

[[PAI_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|Actions for Individuals]]

= Sources =

----

#Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016.
#CACDA Administration of Narcan. 2017  [http://www.cadca.org/resources/coalition-action-meriden-healthy-youth-coalition-mhyc-provides-life-saving-overdose [1]]
#100 Million Healthier Lives City, Town-Wide, and Regional Efforts.[https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_ https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_]
#100 Million Healthier Lives City, Town-Wide, and Regional Efforts [https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_ https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_]
#100 Million Healthier Lives City, Town-Wide, and Regional Efforts.[https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_ [2]]
#[http://www.rehabs.com/pro-talk-articles/the-ultimate-harm-reduction-guide-to-drug-mixing/ http://www.rehabs.com/pro-talk-articles/the-ultimate-harm-reduction-guide-to-drug-mixing/]
#[https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/ https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/]
#[https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/ https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/]
#[http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html]
#[http://www.minnesotarecovery.org/files/FINAL_Good_Samaritan_Postcard.pdf http://www.minnesotarecovery.org/files/FINAL_Good_Samaritan_Postcard.pdf]
#[http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html]
#[http://www.pharmacy.ca.gov/publications/naloxone_media_release.pdf http://www.pharmacy.ca.gov/publications/naloxone_media_release.pdf]
#Police Executive Research Forum. 2016. Building Successful Partnerships between Law Enforcement and Public Health Agencies to Address Opioid Use. COPS Office Emerging Issues Forums. Washington, DC: Office of Community Oriented Policing Services. [https://ric-zai-inc.com/Publications/cops-p356-pub.pdf https://ric-zai-inc.com/Publications/cops-p356-pub.pdf]
#[https://www.bjatraining.org/tools/naloxone/Liability-and-Risk https://www.bjatraining.org/tools/naloxone/Liability-and-Risk]
</div>
[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Treatment and Recovery]]

User:Katherine R.

2021-04-12T16:12:57Z

Snkennedy3327: Creating user page for new user.

SAFE Project is a national nonprofit working through a collaborative, multi-pronged and non-partisan approach to end the nation's catastrophic addiction epidemic.

User talk:Katherine R.

2021-04-12T16:12:57Z

Snkennedy3327: Welcome!

User:K.castelo

2021-03-23T14:25:35Z

Snkennedy3327: Creating user page for new user.

Hi Steve,

This is Tracy Steffek and I am requesting an account for Katherine Castelo our new Director of SAFE Solutions. Richard Washington's contract with us is wrapping up on March 31, 2021.

Thank you!

User talk:K.castelo

2021-03-23T14:25:35Z

Snkennedy3327: Welcome!

User:RFlanagan

2021-01-21T18:32:13Z

Snkennedy3327: Creating user page for new user.

Management Consultant, Strategy Specialist

Specialties: social impact investing, strategic planning, IT strategy, product strategy, product and services launches, professional development, talent management, professional services practice and communications, corporate identity and global branding, vendor portfolio management, trend analysis.

Industries: financial services, advanced technology, healthcare, oil and gas, luxury goods, lifestyle social media and platforms, non-profit and philanthropy, media aggregation, community development.

User talk:RFlanagan

2021-01-21T18:32:13Z

Snkennedy3327: Welcome!

User:Mredden

2021-01-21T18:30:00Z

Snkennedy3327: Creating user page for new user.

I am a Communications Manager at SAFE Project helping with SAFE Solutions.

User talk:Mredden

2021-01-21T18:30:00Z

Snkennedy3327: Welcome!

MediaWiki:Sidebar

2021-01-08T01:21:23Z

Snkennedy3327:

Activating Your Community

2020-12-21T18:09:27Z

Snkennedy3327:

__NOTOC__ Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]   
SWITCHING TO "Activating Your Community

__TOC__

 

 

= Background =

There are many barriers that prevent and limit the efforts of communities addressing drug misuse and substance use disorder, but one particular challenge that many communities face is the ability to elevate their initiative above other local competing priorities.  Identifying champions who can publicly support the coalition’s mission can help to build and foster strategic partnerships, generate buy-in, and increase commitment to bolster supports. With a solid understanding of the current programmatic needs in your area, you can build power and mobilize the community by successfully bringing together advocates, policymakers, and professionals to take collective action.

Whether you are developing legislative or regulatory efforts, building and strengthening programs, or attempting to reach a diverse audience with a wide range of needs, communities of all sizes should consider the following principles when activating your community around this crisis:

*Put equity at the center for your efforts
*Engage individuals with lived experience or those directly impacted by substance use disorder in decision-making roles
*Create alliances and form strategic partnerships that build political will and support from a broad range of stakeholders
*Build relationships with federal, state, and locally elected leaders
*Understand your community’s most powerful levers for change 
*Allow data to drive your strategy development and decision-making
*Focus on measurable individual and community-based outcomes
*Empower citizens by increasing public awareness and community engagement opportunities
*'''Strengthen your system or infrastructure in order to achieve impact at scale'''

It’s important to note that any community organizing or political will building strategy should be implemented with regularity - it should not be a single event or effort.  For the greatest impact, communities should show the link or intersection of substance use disorder with other competing community priorities, consistently focus on drumming up new interest, and relay progress made over time back to community stakeholders using a message of hope in order to sustain engagement.

Drug misuse and SUD has consequences for all residents of local communities.  The current epidemic increases costs related to public health, public safety, criminal justice, treatment services, and many more.  Locally elected leaders are typically motivated by the economic impacts to improve local response, but a far greater price comes from the fatalities caused by the epidemic and related overdoses and the loved ones who must face the pain of those lost.  This is what motivates many others to create and join efforts to combat the epidemic within their communities.  Many of these leaders typically work in prevention, harm reduction, treatment, recovery support services, and other efforts that save lives and help those in need find recovery, but it may be necessary for communities to tailor messaging to suit a wide variety of audiences in a manner that speaks to the receiver’s particular interest.  When identifying champions or strategic alliances, communities should consider their most powerful levers for change.  Who or what in your community can unlock opportunity and accelerate change?  What is the backbone of your community?  Is it your local hospital system, community college, or a specific business or company?  Communities may find that some individuals or organizations may have conflicting viewpoints – try to approach them and open a door for conversation.  Sometimes non-traditional partners are only “non-traditional” because we label them as such.

 

= Key Community Members =

== Elected Officials and Local Health Leaders ==

Locally elected leaders and health officials can play a key role in leading efforts to improve the response to the SUD epidemic.  Mayors, County Executives, County Managers, Commissioners, and the local health leaders they appoint, can be powerful allies in raising public awareness about the extent of the problem, the availability of resources, and providing information on specific strategies, like harm reduction, that can help save lives.  In many instances, elected officials and local health officials might already be part of some type of community task force or other group charged with coordinating and improving local response to the epidemic; however, in the absence of such an effort, elected and health leaders can and should be engaged in raising awareness about the issue and solutions while also increasing support within the community.  

Elected leaders, and especially legislators, play an important role in the creation of budgets and ultimately decide on how local revenues are allocated to different programs, so it is critical they are aware of the scope of these issues in their communities and what is being done in response.  In most cases, they have political allies and are regularly invited to speak at community events or participate in meetings with diverse audiences where they can help to relay your message and share information about the response.

Although locally elected leaders are important champions, it’s also critical for a coalition to work alongside its state partners to help align efforts for maximum impact, inform policy, support funding, and make recommendations on scalability of programs that are working on-the-ground to avoid duplication or manage expectations that might not be feasible or sustainable at the local level.

=== Engagement Examples - Elected and Local Health Leaders ===

== Community Stakeholders and Infuencers ==

Anyone in your community can be a leader or a champion.  Drug misuse and substance use disorder affects a substantial number of residents in all communities.  Having a wide variety of stakeholders imbedded within the community can help to advance policies, programs, and systems that can work together and improve local response.  When appropriate, consider engaging other community partners to leverage efforts and boost support within the community.  These individuals in your community who could be key champions or partners along the way, but might not necessarily participate in the coalition.  Some examples might include:

*Health Professionals and Community Health Centers
*Hospital System Administration
*Faith Leaders
*Law Enforcement or other First Responders
*Public and Private School Systems
*Colleges, Universities, and Institutions of Higher Education
*Parent Groups
*Youth and Young Adults
*Local businesses, corporations, or the Chamber of Commerce
*Philanthropic Community

== Individuals with Lived Experience ==

Communities should also engage individuals with lived experience in decision-making roles - meaning those who have had first-hand involvement with substance use disorder and those who are friends or family members of those directly impacted.  Individuals with lived experience bring knowledge, understanding, and experience not learned through formal education.  To be most effective, it is imperative that communities honor and reflect the voices of those most impacted in their programs and systems. If possible, find ways to offer fair compensation for their time.  

= Improving Pubic Awareness And Engagement =

Public education and awareness is essential to activating a local community.  Residents need to know the unvarnished reality of what is taking place.  They need to know what the problem is, and what needs to be done to improve the local response and save lives.  In addition order to be educated, local residents also need to be involved in the process.  The people are the community, and many have first-hand experience with drug misuse and SUD.  Many others have lived experience with family and friends who are struggling with these issues, and their input and participation is needed to create a Comprehensive and effective Community

 

== Public Availability of Data ==

 

== Community Education Programs ==

 

== Building Strategic Partnerships ==

 

== Develop Outreach Strategies ==

 

 

= Overcoming Stigma =

== Anti--Stigma Campaigns: ==

[http://www.safeproject.us/noshame SAFE Project’s #NoShame Pledge] – This virtual campaign helps to combat negative perception and offers support to others when seeking treatment or speaking up about mental health and substance use disorders.  It was designed to include a toolkit for communities who want to replicate the campaign locally and use it a community mobilizing tool to drum up political will and raise awareness about local efforts underway to combat stigma.  By using the pledge as a catalyst, communities can identify new stakeholders who can be activated and drive social impact, as well as help to change behaviors at scale.

State of Massachusetts - Sate Without StigMA. <ref>https://www.mass.gov/state-without-stigma
</ref> The State of Massachusetts has developed a comprehensive anti-stigma campaign at the State level.  This resource provides information about what stigma is, how it contributes to the current epidemic, and personal stories of people who talk about their own experiences with stigma and how they overcame it to find help for themselves and others in a variety of settings.

 

  

[[Category:Community Resources]]

Prevent First Time Use and Misuse through Education

2020-12-21T18:08:06Z

Snkennedy3327: Snkennedy3327 moved page Educate Communities to Prevent First-Time Use and Misuse to Prevent First Time Use and Misuse through Education

''Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] ''

----

 

 

 

 

= Overview =

Prevention is defined as the action of stopping something from happening or arising.  Prevention through education can be an effective way to prevent drug misuse and substance use disorder, which will reduce the numbers of overdose and fatal overdose within a community.  These are often longer term strategies, especially within the context of educating young people about the dangers and realities of starting to use substances.  

Educational prevention programs can - and should - start at an early age.  Society often promotes and glamorizes substance use, and young people are often exposed to substance use within their families and often feel peer pressure from friends who are using substances.  These are powerful forces in a young person's life that can be counteracted with effective education programs.

Education and prevention is an important part of helping individuals understand the dangers of drugs and alcohol. The main focus of drug education and prevention is teaching individuals about drug and alcohol abuse and the harmful impacts it has on people's lives.  For this reason hearing stories from those with lived experience is a powerful prevention tool.  There is no substitute from being face to face with someone and hearing first hand what their experience was like. These and other types of programs can help a person learn how to avoid, stop, or get help for addiction. 

Efforts also include those that target parents and provide them with the tools needed to educate their children about the dangers of drug use.  Parents are also educated to bet aware of warning signs that their child may already be using.  This can lead to an early intervention that often prevents the progression into substance use disorder.

The types of prevention programs are nearly endless.  Many successful approaches have been developed to target all types of populations.  Programs have been developed to focus on different age groups, different racial and ethnic backgrounds, schools, families, faith-based organizations, doctors, pharmacists, and the wider community.  The types of prevention programs are also extensive.  While many focus on the impacts of drug use (including different drugs like prescription medications), others focus on building up the individual and helping them address risk factors like anxiety and trauma that often lead to drug use.  Other prevention programs take the form of public awareness campaigns that seek to educate and warn large numbers of people. A good overview of prevention programs can be found [https://www.unodc.org/documents/drug-prevention-and-treatment/UNODC_UNESCO_WHO_GoodPolicyAndPracticeInHealthEducation.pdf here].

 

 

= Key Topics and Strategies =

The following resources pages focus on a number of key strategies that have been effective in preventing first time use and abuse.

One area of focus involves know the dangers of prescription medications, especially opioids and other pain medications.  The "first wave" of te current epidemic started when powerful pain medications were developed, heavily marketed, and often over-prescribed.  The addictive nature of these medications was largely unknown, and millions of people developed substance use disorder as a result.  Strategies include how to educate both patients who are prescribed these medications and parents of children who may be prescribed - or given the option to be prescribed - pain medication.

Young people are perhaps the most critical population to target with prevention programs.  Strategies included target where young people are located and the unseen risk factors that often lead to drug misuse and substance use disorder.  School based prevention programs are highlighted, including how to educate youth and create resistance to peer pressure to use drugs.

Looking at the underlying trauma and other mental health challenges many youth face is truly at the core of effective prevention.  Many people first start misusing drug to self-medicate and escape the depression, anxiety, and anger caused by traumatic events they have experienced.  Even without major trauma, an increasing number of young people are feeling stress and anxiety at high levels where again they seek relief by using drugs.  Educating youth about this reality and encouraging them to express these feeling and get needed help can achieve tremendous benefits for the individuals and entire community,

 

 

 

= References and Related Articles =

U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, [https://www.ncbi.nlm.nih.gov/books/NBK424857/pdf/Bookshelf_NBK424857.pdf Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health]. Washington, DC: HHS, November 2016.

Hanley Foundation.  The [https://hanleyfoundation.org/prevention/ Hanley Foundation] is a national non-profit with a variety of prevention initiatives.  

United Nations Educational, Scientific and Cultural Organization. Good Policy and Practice in Health Education - "[https://www.unodc.org/documents/drug-prevention-and-treatment/UNODC_UNESCO_WHO_GoodPolicyAndPracticeInHealthEducation.pdf Education Sector Responses to use of Alcohol, Tobacco and Drugs]."

Educate Communities to Prevent First-Time Use and Misuse

2020-12-21T18:08:06Z

Snkennedy3327: Snkennedy3327 moved page Educate Communities to Prevent First-Time Use and Misuse to Prevent First Time Use and Misuse through Education

#REDIRECT [[Prevent First Time Use and Misuse through Education]]

Supporting Key Legislative and Policy Changes

2020-12-21T18:06:17Z

Snkennedy3327: Snkennedy3327 moved page Adopt Key Legislative and Policy Changes to Improve Response to the Epidemic to Supporting Key Legislative and Policy Changes

<div class="wiki" id="content_view" style="display: block">
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map ]]or the [[ZOOM_MAP_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map - Expand Harm Reduction Practices Associated with Opioid Misuse]]

 

 

= Background =

Educating policymakers and the general public about the legislative or policy changes necessary to create change in your community is an important step to addressing substance misuse and SUD. Policies help states and local communities in several important ways:

1. By providing direct funding to communities for treatment and other services.

2. By improving access and/or affordability of care to individuals in need of assistance.

3. By removing barriers that prevent or limit the use of best practices across government agencies.

Policy changes can take place at all levels of government.  This page will provide information about how policy changes typically take place, as well as some examples of federal, state, and local laws that have helped local communities.  

 

= Policy Advocacy =

== Initial Steps ==

In order to bring about policy changes through laws or ordinances, any group of citizens must be able to become a "constituency of consequence" to those with the ability to create and change policy.  This can be accomplished with a number of different advocacy approaches, as highlighted below.  A few key principles to change policy at any level of government include:

1. Have clear policy objectives.  The more specific and narrow the objective the better.  If the policy goals are too broad or general, it is easy for legislators to object on that basis.

2. Support your position.  Have research and data to support why the policy change you are seeking would be beneficial.  For example, if seeking to improve harm reduction through the creation of a needle exchange program, provide data on expected lives that will be saved, reduced medical costs, improved linkages to care, and other benefits.

3. Build a coalition.  It is important to build a coalition to increase political clout.  Think about other groups within the state or local community whose goals align with yours that would support your policy objectives and who would be willing to take action in order to achieve it.  For example, if you were advocating for a needle exchange program, you might seek support from harm reduction organizations including hospitals, community health organizations and professionals, the recovery community, families in support of recovery, the treatment community, and potentially many others.  

4. Know your opposition.  If a policy change hasn't happened, it is likely opposition exists.  It is important to learn why policymakers may be hesitant to make a certain change, including what groups oppose the policy and why.  Learning about the other side is critical to developing an effective advocacy strategy.  Overcoming opposition may require education, effective counter-arguments, financial resources, and increased public awareness.

5. Identity champions.  The most successful efforts resulting in desired policy changes are led by individuals who are passionate about the issue.  Identifying and working with champions in the state or local government is a big key to success.  It is important to have people "on the inside" that can hold hearings, develop legislation, utilize input and information from stakeholders, and provide insight on the process.  Leaders within the coalition of groups seeking the policy change are also critical to identify.

6. Your voice matters.  Many times, individuals or groups with minimal advocacy experience can be intimidated by the process.  Remember that those "in power" are there because they were elected to serve.  Lawmakers across all levels of government represent the people of their states, districts, cities, towns, and so forth.  It is your constitutional right to petition the government and be heard.  Those representing the people need to hear the concerns of all those they represent.

 

== Into Action ==

After taking the initial steps to organize, conduct both supportive and opposition research, identify champions, and reach consensus on what the policy objective(s) should be, the next step is identify and implement a set of strategies that will grow public and political support for those policies.  While approaches and specific strategies and almost innumerable, taking action involves communication and messaging intended to educate and influence.  

=== Grassroots Advocacy ===

Grassroots Advocacy generally refers to engaging the public to actively educate and lobby on behalf of a desired policy objective.  Communication occurs through letters, emails, calls to legislators, rallies, social media campaigns, letters to the editor, and other forms of messaging campaigns designed to put political pressure on policymakers to enact desired changes.  A good overview of grassroots advocacy can be found [https://www.gih.org/files/usrdoc/Grassroots_Advocacy_Sunflower_Foundation_November_2010.pdf here].

=== Direct Lobbying ===

Direct lobbying refers to direct communication and meetings with policy makers, most often governors, mayors, county executives, and the legislative branch at all levels of government. This key activity provides the opportunity to meet with decision makers and their staffs to discuss the desired policy goals, the benefits and support, address any likely opposition, and gage the receptiveness of the policymakers.

Opportunities for direct lobbying often take place during the legislative session, which varies from jurisdiction to jurisdiction.  Some advocates and interest groups will organize a "lobby day" where members converge in Washington, state capitols, or with local legislative bodies to advocate for desired policy objectives.  When the legislative body is not in session, advocates can meet with their representatives at their local offices.  A good resources on the process of influencing policy can be found [https://ctb.ku.edu/en/influencing-policy-development here].

 

= Lobbying Rules and Restrictions =

Lobbying rules vary widely between levels of government and across all states.  It is, therefore, important to know how lobbying is defined and what the restrictions are in the jurisdiction you are involved with.  Some fundamentals include:

501(c)3 organizations (tax-exempt nonprofits) have some restrictions on lobbying in the government. [http://www.cadca.org/sites/default/files/resource/files/strat31.pdf This guide] explains federal laws on non-profit lobbying for policy changes. 

The IRS defines direct lobbying as: "A direct lobbying communication is any attempt to influence any legislation through communication with: Any member or employee of a legislative body; or Any government official or employee (other than a member or employee of a legislative body) who may participate in the formulation of the legislation, but only if the principal purpose of the communication is to influence legislation."<ref>Treas. Reg. Sections 56.4911-2(b)(1)</ref>

Direct Lobbying Communication is defined as: "Referring to specific legislation and reflects a view on such legislation."

The IRS defines grassroots lobbying as: "any attempt to influence any legislation through an attempt to affect the opinions of the general public or any segment thereof."

Grassroots Lobbying Communication is defined as: "Referring to specific legislation; reflecting a view on such legislation; and encouraging the recipient of the communication action with respect to such legislation." 

 

= The Legislative Process =

== Overview ==

The legislative process of course varies between different levels of governments and in jurisdictions across the country.  There are typically several steps in the process that provide opportunities to influence policymakers as when they are in session.  Some states and localities have relatively short time frames to consider and pass new laws or ordinances, while other states and the federal government are in session for the many more weeks throughout the year.  It is, therefore, important to know when the actual work of policy development and consideration takes place in the legislative body where you want the change to happen.

== Sponsors and Early Support ==

In any legislative body, a successful policy enactment starts with one or more members of the legislative body drafting legislation that would bring about the desired change.  Members can do this individually or as a group.  A member or group of members that introduce a legislative proposal are typically referred to as sponsors or "original" sponsors of the proposal.  Other members can then sign on in support of the bill as co-sponsors.

Effective advocacy can help build momentum for a bill during this process.  The more sponsors and cosponsors, the better.  It is also extremely beneficial to have early supporters from both political parties - especially at the state and federal level.  Bipartisan support, and support among a broad base of members at the local level, can show other members that the bill is likely not controversial.  It is also especially helpful for key committee leaders with jurisdiction to support the proposed legislation.

Advocates can provide their champions within the legislature with all of the supporting information and research to help their champions in the legislative body attract as many co-sponsors as possible and respond to questions or objections as they arise.

== Committee Process ==

Typically, legislative proposals are taken up by the committee (or committees) of jurisdiction.  Actual consideration of a proposal often takes place after one or more committee hearings on the proposal.  This often involves hearing from witnesses in support of, and potentially in opposition to, a given proposal.  Written testimony is also included in the public record to provide additional information to both the public and the legislators.  The hearing process provides another opportunity for advocates to testify as a witness and/or provide information to be included in the record.  Hearing can take place in front of the full committee or by a sub-committee which oversees the specific policy area impacted.

After the hearing process, the bill may be taken up by the full committee for consideration.  Although the bill can be altered by the manager of the bill at any time, consideration by the committee is the first time lawmakers have an opportunity to propose amendments to the proposal.  These amendments are voted and adopted, or not adopted, by a majority vote.  Following the amendment process the committee chair can call for a final vote on the legislation.  If passed, the bill can move to the full legislative body for consideration.

Advocacy efforts can move quickly during the committee process, as unexpected challenges may surface due to an unfriendly amendment that might weaken the bill and the policy impact desired.  It is important to work with allies to carefully track this process and respond to any negative developments.

== Consideration by the Full Body ==

At the local level, there is a single body that approves local legislative proposals.  This is typically a Board of Commissioners or other duly elected body.  At the state and federal levels, there are two legislative chambers, with delegates and senators at the state level, and the House and Senate at the federal level.

The process is usually relatively simple at the local level.  Legislation (or ordinance) proposals are taken up at regularly scheduled meetings where a debate occurs, amendments are offered, and the proposals are voted on.  Often, the chief executive at the local level has a vote along with the other members.

At the state and federal level, the process is more complex.  A bill has to pass both chambers before it can be reconciled, voted on again by both bodies, and sent to the Governor or President for signature.  While on the floor, members can again offer amendments that can be voted on individually or en bloc.  Typically, more controversial amendments will be voted on by individual basis.  Assuming the bill passes, it is sent to the other body for consideration.  A similar or identical bill may be in process in that other chamber already, or it may be that no companion legislation exists.  In the latter case the chamber that did not originate the bill will take up the version that was passed in the other chamber.

When a bill does pass both chambers, there are almost always differences that must be worked out.  The committee chairs will select a reconciliation committee with a bi-partisan group of legislators from both chambers to accomplish this.  Assuring any differences can be worked out, the bill then goes back to the floor of each chamber for a final vote.  If passed, the bill is finally referred to the Governor or President.

As with the Committee process, advocacy must continue throughout the time in which a bill is considered by the full legislative body.  At the state and federal levels, this can be a challenge with many steps involved and a larger number of legislators to contend with - some of whom my not be supportive.  Again, it is critical to stay in constant contact with supporters within the legislative body to keep track of potential harmful amendments and keep count of likely supporters within the full body.  At times advocacy efforts need to be focused on a handful of legislators who have reservations or are undecided.

== Potential Veto and Override ==

Although rare, Governors and the President may veto a bill passed by the state and federal legislators.  If the vote on final passage were close, it is unlikely that the bill will be taken up again, as a two-thirds majority is needed to override a veto.  If the original vote was approached the two-thirds number, there is a better chance to find the supporters needed for a successful override. 

== Continued Funding (Budget and Appropriations) ==

Even when a law or ordinance is passed and signed by the chief executive, advocacy efforts often do not end.  This is due to the fact that legislation containing funding to implement programs is authorized (usually for a period of years), but there is still a budget and appropriations process that must be monitored over the authorization period.  Typically, the executive branch of government produces an annual budget that reflects their policy and spending priorities.  The budget may or may not be approved by the legislative body.  After this point the legislative body will take up annual appropriations bills, which set spending levels for all agencies and their programs.  These bills often work through the regular order of other legislation, but sometimes will have a different, often expedited process.  

It is important for community coalitions and advocates to understand that funding for the agencies and programs they support can change through each step of the budget and appropriations process.  There is a need to stay vigilant and ensure full funding is achieved.  Advocates must stay in touch with their champions in the executive branch and legislature to keep informed of any changes and be ready to advocate just as vigorously as when it is done with new initiatives in order to restore any proposed cuts in funding.

== Example of Advocacy Strategies within the Legislative Process ==

The following illustrates some of the partnerships and strategies used to pass an important piece of legislation in the state of Illinois:

'''[[Illinois_SB2928|Illinois]]''' '''[[Illinois_SB2928|SB2928]]''' is a current law with the common name '''"'''Lake County Prescription Drug Disposal Pilot Program" which had been adopted in 2014 and is currently still functioning, losing its Pilot portion of title in 2015. [17][18] It has been shown to be a model by which many organizations and local governments can partner with one another to improve outcomes in drug recovery and disposal efforts. [19] The lead Project Coordinator Bill Gentes has as a result been awarded CADCA's Advocate of the Year.[20] The following steps were used in the creation, adoption and advocacy for this bill that allowed successful passing of it within the 98th general assembly:

#Investigation of Previous Regulation and Legislation - As is shown in the Securing Public-Private Partnerships section, it is required that one review current legal standings to determine if advocacy for amendment is required to allow for a more proactive approach to drug prevention to exist.
#Partnering with Local Law Enforcement - As stated by Gentes at an interview "“''circling back to law enforcement and telling them, ‘look, you guys dropped off 500 pounds and I want to tell you want that means,” makes it easy for those police departments to then get their mayors, and their village boards invested in the process''."[21] In many jurisdictions, it is regulated that only police forces may collect excess pharmaceutical products, which increases the need to partner with Local Law Enforcement even more. [22]
#Gaining support of Local and Community Leaders - Primarily through the method discussed in Partnering with Local Law Enforcement and through advocacy and education efforts, to have a bill passed one must show support at the local level as well as demonstrable results of local programs to garner such support. As Stated in the Route 50 Article: "Another goal for Gentes was to uncover and take advantage of the data coming out of the collection boxes. When scheduled substances are found within the boxes, the contents and amount is noted. This isn’t merely a measure to satisfy curiosity. Rather, Gentes uses the data collected as a tool to recruit new police departments to the program, and to remind participating police departments that their efforts are making a difference...''.'look, you guys dropped off 500 pounds and I want to tell you want that means,” makes it easy for those police departments to then get their mayors, and their village boards invested in the process.'''"[23]
#Securing Public-Private Partnerships - Walgreens has been approached by Gentes and worked to create Prescription Drop Off and Secure Sites with partnership with local police forces and legislature. Currently expanding their drop off points to several states, there appears to be issue with a need to review current laws regarding drug disposal. [24] This has as a result increased the capacity of the project and accompanying police force in collection efforts.
#Advocating for Adoption from State Officials - Through previous methods listed, especially community advocacy efforts, the proposal was adopted as a bill partly through the efforts of sponsor Senator Terry Link, and went on to receive unanimous support. [25]
#Securing Funding For A Statewide Program - In the Example of SB2928, funding would be secured in law through the Illinois EPA with the rationale that disposal of such materials would prevent drugs from tainting local water supplies, though it should be noted that labor and supplies were primarily used from local Law Enforcement Departments. [26][27]

= Examples of Federal, State, and Local Initiatives by Topic =

States and localities vary widely on what types of laws are implemented across multiple policy areas. Below are a few examples that can provide your community coalition with some ideas on what has been passed in other states and localities.

== Prevention and Reduced Access to Prescription Medications ==

New Jersey - [http://www.nj.gov/lps/ca2/pmp/ New Jersey's Prescription Monitoring Program]

California (Alameda County) - Local ordinances that require drug manufacturers to establish and fund a drug disposal program.[8]

Connecticut - [https://www.cga.ct.gov/2016/ACT/pa/2016PA-00043-R00HB-05053-PA.htm Statute] enacted May 2016: Seven-day limit for new opioid prescriptions for adults and all opioid prescriptions for kids. Exceptions for chronic and cancer pain, palliative care, and clinical judgement.[9] 

Illinois - [http://www.ilga.gov/legislation/publicacts/99/PDF/099-0480.pdf Statue] enacted September 2015: Schedule II prescriptions limited to a 30-day supply (with exceptions). Allows multiple prescriptions up to a 90-day supply if the prescriber meets specified conditions.[10]

 

== Harm Reduction ==

Syringe Access Locations - [https://opioid.amfar.org/indicator/num_SSPs [1]]

National Harm Reduction Coalition - [https://harmreduction.org/issues/syringe-access/landscape-report/ Resources for Syringe Access and Policy]

Rhode Island - [https://preventoverdoseri.org/fentanyl-test-strips/ Fentanyl Testing Strip Program]

 

== Access to Treatment and Protecting Treatment Services ==

'''Federal Government - Affordable Care Act (2010)''' - More than 20 million people received support to get mental health and substance abuse treatment through the 2010 ACA.[15] If it is repealed and its replacement does not offer the same coverage many people will be unable to get to access treatment for addiction. The New York Time's Editorial Board states that "repealing the health care law is likely to exacerbate the crisis."[16

California legislation has a process for reducing treatment fraud and waste: [https://www.behavioral.net/news-item/policy/calif-bill-targets-profiteering-addiction-treatment-dialysis-industries [1]]

 

== Criminal Justice Reform and Decriminalization. ==

Good Samaritan Laws provide immunity from criminal prosecution for drug crimes to those who use drugs and those who act in good faith and call emergency services during an overdose.[6] The Policy Surveillance Program provides an [http://lawatlas.org/query?dataset=good-samaritan-overdose-laws interactive database] of current Good Samaritan Laws in the U.S. As of July 2016, 35 states and Washington D.C. had Good Samaritan Laws in place.[7]

Oregon - Recent State Initiative to Decriminalize almost all narcotics:  Measure 110, passed by a majority of statewide voters in November 2020, decriminalizes the possession of marijuana and small amounts of "harder" drugs including cocaine and methamphetamine and reduces criminal penalties for larger amounts.  A good summary of the measure can be found [https://apnews.com/article/oregon-first-decriminalizing-hard-drugs-01edca37c776c9ea8bfd4afdd7a7a33e here].

Washington State - [http://leadkingcounty.org/about/ Law Enforcement Assisted Diversion]

 

== Recovery Support Services ==

Federal SUPPORT Act: Sec. 7151. Building Communities of Recovery This section amends the Building Communities of Recovery (BCOR) program that was first authorized in the Comprehensive Addiction and Recovery Act (CARA) of 2016 by redefining “recovery community organization” as an organization that mobilizes resources within and outside of the recovery community, including through a peer support network. This section authorizes $5 million for each of FY 2019-2023.  

Federal Support Act: Section 7031. National Recovery Housing Best Practices This section amends part D of title V of the Public Health Service Act to authorize the Sec. of HHS to identify or facilitate the development of best practices for operating recovery housing. The Secretary is directed to bring together a wide variety of stakeholders to develop best practices for Recovery Housing.

= Federal and State Policy Plans to Address the Opioid Epidemic =

Governments at all levels will frequently create their own set of policy goals to address a particular issue.  This has been true for several public health issues including the current opioid epidemic.  This process typically involves bringing numerous stakeholders together to provide education and input in coordination with government representatives who initiate the process and finalize the set of policy objectives.

 

== Recommendations from the 2017 President's Commission on Combating Drug Addiction and the Opioid Crisis ==

*Establish and fund a federal incentive to enhance access to Medication-Assisted Treatment (MAT)
*Mandate Prescriber Education
*Require that all modes of MAT are offered at every licensed MAT facility and that those decisions are based on what is best for the patient.
*Partner with the National Institutes of Health (NIH) and the industry to facilitate testing and development of new MAT treatments.
*Provide model legislation for states to allow naloxone dispensing via standing orders, as well as requiring the prescribing of naloxone with high-risk opioid prescriptions; we must equip all law enforcement in the United States with naloxone to save lives
*Develop and disseminate Fentanyl detection sensors
*Support and fund interstate sharing of PDMP data
*Better align, through regulation, patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that information about SUDs be made available to medical professionals treating and prescribing medication to a patient. This could be done through the bipartisan Overdose Prevention and Patient Safety Act/Jessie’s Law
*Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses verses physical health diagnoses

== Rhode Island ==

*[http://www.health.ri.gov/news/temp/RhodeIslandsStrategicPlanOnAddictionAndOverdose.pdf Rhode Island's Strategic Plan on Addiction and Overdose]

== Massachusetts ==

*[http://www.mass.gov/eohhs/docs/dph/stop-addiction/recommendations-of-the-governors-opioid-working-group.pdf Recommendations of the Governor's Opioid Working Group]

 

= National Advocacy Groups =

Below are some examples of national advocacy groups:

[https://feduprally.org/ FedUp!]

*A grassroots coalition formed in 2012 that seeks action from the federal government to end the public health epidemic created by opioids
*FedUp accepts no money from pharmaceutical corporations and 100% of the donations they receive are directly applied to managing the costs of hosting their FedUp! rallies

[https://www.thenationalcouncil.org/policy-agenda/ National Council For Behavioral Health] - National Organization the advocates for mental health and substance use policies.

[https://harmreduction.org/ National Harm Reduction Coalition].  Advocates for numerous harm reduction approaches.

 '''SUBJECT MATTER EXPERT''': [fill out table below]

 

 

----

Sources

#[http://www.cnn.com/2016/04/28/opinions/massachusetts-opioid-treatment-prince-vox/?iid=ob_article_organicsidebar_expansion [4]]
#[http://www.modernhealthcare.com/article/20160615/NEWS/160619941?utm_source=modernhealthcare&utm_medium=email&utm_content=20160615-NEWS-160619941&utm_campaign=am [5]]
#[http://www.ucirvinehealth.org/health-library/content/?contentTypeID=6&contentID=712214 [6]]
#[http://content.healthaffairs.org/content/35/10/1876.abstract [7]]
#[https://www.justice.gov/file/822231/download [8]]
#[http://www.countyhealthrankings.org/policies/good-samaritan-drug-overdose-laws [9]]
#[http://lawatlas.org/query?dataset=good-samaritan-overdose-laws [10]]
#Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [11]]
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [12]]
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [13]]
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [14]]
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf 16]]
#[https://www.nytimes.com/2017/01/16/opinion/young-victims-of-the-opioid-epidemic.html [17]]
#[https://www.nytimes.com/2017/01/16/opinion/young-victims-of-the-opioid-epidemic.html [18]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [19]]
#[http://www.ilga.gov/legislation/98/SB/09800SB2928.htm [20]]
#[http://police.mundelein.org/content/pill-disposal-program [21]]
#[http://www.cadca.org/resources/coalitions-action-how-bill-helped-pass-law [22]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [23]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [24]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [25]]
#[http://police.mundelein.org/content/pill-disposal-program [26]]
#[http://www.ilga.gov/legislation/98/SB/09800SB2928.htm [27]]
#[http://police.mundelein.org/content/pill-disposal-program [28]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [29]]
#[http://www.cadca.org/sites/default/files/resource/files/strat31.pdf [30]]
</div>
[[Category:Pages with broken file links]]

Adopt Key Legislative and Policy Changes to Improve Response to the Epidemic

2020-12-21T18:06:17Z

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#REDIRECT [[Supporting Key Legislative and Policy Changes]]

Improve Data Sharing, Analysis, and Monitoring

2020-12-21T18:04:55Z

Snkennedy3327: Snkennedy3327 moved page Improve Data Sharing and Analysis to Improve Data Sharing, Analysis, and Monitoring

Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]

 

Data collection, analysis, and reporting are critical components to strengthening a community’s response to drug misuse and substance use disorder.  By sharing and regularly monitoring data, communities can build credibility, raise awareness and political will, share knowledge, identify more effective interventions and strategies, guide decision making, and allow for better budgeting and allocation of funds.  For a community coalition to be successful, it will need to understand how the community perceives a number of elements of addiction, as well as what resources are already at work across the many stakeholder sets in your community.

 

__TOC__

 

= Understanding the Problem =

A key goal of any effort to address the current epidemic is to use multi-sector data to inform assessment, planning, and implementation.  It is not uncommon for most communities to have to break down existing data silos so that various public, private, and community partners can engage effectively.  This process is important because it increases understanding and fosters collaboration.  All participants need to understand what is happening in their community in order to have agreement about what strategies would be most effective. 

== Where to Start and Key Questions to Consider ==

Substance use disorder and drug misuse are complex problems requiring a complete set of solutions.  Data collection and building a sufficient data set can often be challenging, so communities should expect to be met with some level of resistance.  Many agencies who represent important sources of data are often not accustomed to working with others and sharing the data they have available.  There might be questions of confidentiality and many communities work hard to establish trusting relationships with outside entities.  One way to overcome this challenge is to first establish an identified leader(s) to coordinate and gather needed data and regularly summarize and report on data findings.  These are often individuals in the public health sector, who have the experience and expertise necessary to collect, analyze, and present data in a way that is clear and easy to understand.  Once leadership of the data effort is determined, discussions can take place between agencies and other sources to determine what data each has, if they are willing and able to share it, and what restriction may exist in doing so.  In most cases all parties want to help save lives and improve their community, and any issues can be worked out with little difficulty.  

In some communities, there may not already be a data collection effort across the entire system.  In that case, start with your exploration of data by looking at the most severe harms - including fatal and non-fatal overdoses.  Knowing the numbers is important to understand the scope of the problem, but to guide response more data is required.  For example, where are the geographic regions of where overdoses occurring?  What are the demographics of those areas?  What type of substance, or combination, is involved?  How often are we collecting data?

This starting point typically leads to other questions that require additional data in order to identify gaps in services and the implementation of strategies to fill such gaps.  Some examples might include:

'''For non-fatal overdoses, how many go to a hospital or community health center?'''

'''How many non-fatal overdoses are revived with naloxone?  Who administers naloxone - first responders or others?'''

'''Are there clusters of overdoses occurring in specific areas and neighborhoods?'''

'''What are we currently doing?  Are overdose prevention services being offered in areas with high overdose rates?  '''

'''What drugs are residents using?  What are the trends?  What are youth substance use rates?  '''

'''What are the local opioid prescribing practices?'''

'''Are people experiencing overdose being connected to services?  How is this being done, and by whom?'''

'''Are area treatment and other support services at capacity?  Are there wait times or wait lists to get in?'''

'''How many who need MAT are receiving it?  Does this include the criminal justice system?'''

'''Are recovery support services - including housing, job training, coaching, and education - available and do they meet the needs of the community?'''

'''For those involved in the criminal justice system, is there a history or presence of substance use problems?'''

== Data Sharing Agreements ==

Collaboration across systems is crucial for any community’s response efforts.  It is important for communities to understand the federal and state legal framework since some data might contain protected health information.  For more information about best practices for sharing data across behavioral health and criminal justice systems, please see [https://bja.ojp.gov/sites/g/files/xyckuh186/files/Publications/CSG_CJMH_Info_Sharing.pdf here].  

Even in situations where agencies wish to share data, often some type of data sharing agreement is required.  Parties will want to know that confidential or other sensitive data will not be disclosed publicly or beyond a limited number of participants.  While the creating of such documents is often done by counsel in order to address privacy issues and compliance with laws and regulations, there are many boiler-plate examples that can be used and altered to meet the requirements of most agencies and other community partners.

Examples of data sharing agreements related to healthcare can be found [https://www.neighborhoodindicators.org/library/catalog/collection-example-data-sharing-agreements-health-healthcare here].

This[https://www.hhs.gov/sites/default/files/new-faqs-on-sharing-information.pdf FAQ] resource from HHS provides information about requiements and limits to information sharing agreements.

== Other Potential Data Sources ==

Before collecting any new data, the next step is to scan existing sources and locate the data.  Identify where the data is currently being captured and who has access to the needed data.  Perhaps, your community has already conducted a recent needs assessment?  During this process, you may find that some data is missing or interpreted differently across organizations.  Spend time with administrators discussing how they compile their data and what data elements are comprised of specific indicators.  To make sure your data is statistically sound and there are no errors, it is important that administrators are working from the same definitions and make an effort to link potential data sources where applicable.  

'''In some cases, you may be able to access local data through public records, but common sources and the types of data organizations can typically provide include:'''

'''Local and State Health Departments (number of overdoses, locations, demographics)'''

'''Fire/EMS Services (portion of overdoses, connection to services, naloxone administration)'''

'''Police and Public Safety Departments (number of overdoses, drug seizures, drug-related crime, diversion, and MAT in correctional facilities)'''

'''Medical Examiner/Corners Reports (cause of death from overdose, type of substance(s) involved)'''

'''911 Calls (calls related to suspected overdose)'''

'''Local Hospitals and Community Health Organizations (number of non-fatal overdoses, connection to services, naloxone administration)'''

'''Local Harm Reduction Service Providers (naloxone and needle distribution, connection to services)'''

'''Treatment Providers (treatment capacity and availability, wait times, MAT providers)'''

'''Pharmacies (records on naloxone distribution to indicate awareness and/or increased use)'''

'''Prescription Drug Monitoring Program (PDMP) (identify high risk prescribers)'''

'''Recovery Support Services (amount and adequacy of peers, availability of housing, access to job training, tracking data on clients remaining in recovery)'''

 

== The Story Behind the Data ==

Communities should explore the ultimate root cause of the problem that might not be immediately apparent.  In addition to the availability of quantitative data, communities may capture and track qualitative data to describe the story behind the numbers through community surveys, listening sessions, public forums, interviews, observations, case studies, or focus groups that analyze trends in drug use, types of drugs, and community perception of the problem.  For deeper examination, ask questions about accessibility, affordability, availability, and cultural relevance of programs and policies.  As you seek input, honor the perspectives and voice of those who will be most impacted by the coalition’s decisions and engage with individuals who you are directly trying to serve in discussions and decision-making in order to understand barriers that residents face.  And, if you are able, provide compensation for their time.  For more information about qualitative and quantitative methods and the role of ethics in research, please see [https://press.rebus.community/introductiontocommunitypsychology/chapter/community-research/ here]. 

The [https://www.safeproject.us/resource/community-pulse-survey/ SAFE Community Pulse Survey] examines your community’s perceptions of the opioid and addiction crisis through a short survey.  It is not mean to be a scientific analysis of attitudes and perceptions, but rather to give you a snapshot of how the community as a whole perceives the issues your coalition will be tacking.  This is also a great way to let the broader community know about your coalition’s focus and to engage with other community members.  Not everyone will agree on the best approaches; the climate survey allows the community to “speak for itself.”  

== Scanning Community Resources ==

Sometimes when individual community sectors do their work to mitigate the opioid and addiction crisis, they are so busy doing good work that they aren’t aware of other services the community offers and how they might interact.  They don’t have the time to survey the landscape and see what else is available.  Focusing your community’s efforts does not mean doing only one thing to combat the epidemic.  By identifying your community’s attitudes and perceptions, as well as gaps in services, you will be better able to focus your available time and energy on paths that have the most opportunity for impact.  [https://www.safeproject.us/resource/community-resources-exercise/ The SAFE Community Resources Exercise] seeks to address this issue by helping coalition members understand the resources their fellow members bring to the table as well as educate the coalition about the depth and breadth of other services that are offered in the community.

== Reviewing Your Assessment ==

Once you have reviewed any existing data, work alongside your stakeholder group or coalition to identify any gaps in data and determine if any new data should be collected.  Did you find everything you were looking for?  How will we know when we have enough data?  Communities can spend a lot of time analyzing and discussing data.  While data should be at the forefront of the coalition’s decision-making, it’s important to balance how much time is dedicated to data discussions and move from planning toward prioritization and action.

 

= Tracking and Monitoring Data =

Communities might initially collect only baseline data, but the benefits of tracking data trends over time include accountability, monitoring changes with statistical significance to act more swiftly, to influence policy, and to communicate and raise awareness about a particular problem.  The identified lead should determine the frequency on how often to collect data and coordinate collection efforts to regularly monitor data.  

Where communities are able, they should disaggregate population level data by race and ethnicity to identify disparities.  Other options for how to disaggregate data include: age, sex, veteran status, marital status, education, citizenship, disability status, primary language spoken at home, and employment status.  Similarly, communities can use their data to drill down to specific areas in the community to explore gaps in access to services and ensure appropriate allocation of resources by analyzing data by city, village, service area, neighborhood, district, or even Census tract.

To help put your community data into context of the bigger picture, you may consider comparing your data or benchmarking across other communities with a similar makeup, your state, and even national levels.  Some national sources of data might include:  

[https://www.cdc.gov/datastatistics/index.html Centers for Disease Control]

[https://www.datafiles.samhsa.gov/info/data-portal-nid17200 SAMHSA] Annual Survey Data

[https://www.census.gov/programs-surveys/acs/data.html Census ACS]

Robert Woods Johnson Foundation - [https://www.countyhealthrankings.org/ County Health Rankings]

 

== Building Performance Measures ==

Developing and tracking performance measures allows community groups to track the impacts of their efforts and help them determine which strategies are working well and which my need to be modified.  It may demonstrate that new approaches are needed.  Tracking progress is also helpful to keeping up momentum - allowing the group to see the beneficial results of their efforts.  Celebrating progress made is important. 

=== Reporting Data ===

It will be up to each community to decide what data to collect and report about, and what data should be made public.  The data report should continually educate and drive informed decision making related to addressing the crises.  Data tracking the number and locations of overdoses, for example, can provide the community with the knowledge of where overdoses are taking place, what hot spots exist, and therefore where focus is needed.  This allows a community to focus resources where they are needed by adding or expanding services like those related to prevention, harm reduction, and connection to services through peers or other means.  Other parts of the reports may include available treatment and recovery housing beds, naloxone distribution numbers, number of prescribed MAT in various setting, number of interventions, and so forth.  What is required is what is needed to first guide strategy and then be able to track the effectiveness of those strategies over time.

Analysts may choose a variety of methods for sharing their data to include Geographic Information Systems (GIS), line graphs, bar charts, tables, and pie charts.  It is critical for an analyst to use care when displaying and illustrating data because it is important to find a balance between creating a visualization that is effective for the reader and providing a picture, but also doing it in a way that accurately displays the data rather than skews the interpretation.  Charts and graphs should be easy to read, aesthetically pleasing, well-labeled, include the totals for columns and rows, be scaled accurately, and developed with the audience in mind.  Illustrate the most important information and keep the graphic simple and ask for help and research best practices if you are not well versed in the creation of charts and graphs.

=== Data Systems ===

To maintain a strong data infrastructure, communities have a variety of options.  Investments in off-the-shelf software systems are available for purchase and can help to combine and monitor data from various state and local organizations, provide a connection to services, and serve as a tool for tracking system performance indicators and outcomes over time.  If there is limited funding available, communities can do this using spreadsheet or database software (like Microsoft Excel or Access).

=== Public Reporting Examples ===

In many cases not all data collected will be made public.  However, developing a data report that is made public is done by most communities due to the fact that it raises awareness about the problem and the real impacts it is having within the community.  This can be done through a dashboard or other regularly updated report made available by local government or a local task force/opioid response team where they exist.

Here are some links to different dashboards and data mapping efforts:

New Hampshire Drug Monitoring Initiative

Allegheny County Data Warehouse

 

= Making Data Informed Decisions =

A targeted data collection and analysis effort will enable decision makers to develop effective approaches to achieve results.  Continued communication and sharing of data is key and will lead to greater collaboration between agencies that have and share data as well as other community stakeholders involved with developing and implementing strategies and programs.  These community stakeholders can help "translate" the data from multiple sources to help with decision-making.  Often new partnerships are forged when the data reveals what needs to be addressed and who can effectively address those identified needs.

Another common lesson learned from experience is that decision makers need to be willing to experiment and constantly adjust the approaches they take.  Even at the local level aspects of this epidemic change and sometimes change rapidly.  Leaders need to continually collect and analyze data in order to detect these changes and make adjustment.

= Additional Resources =

=== New Jersey Overdose Data Dashboard - [https://www.state.nj.us/health/populationhealth/opioid/ https://www.state.nj.us/health/populationhealth/opioid/] ===

=== Cincinnati Overdose Response - [https://insights.cincinnati-oh.gov/stories/s/Heroin-Overdose-Responses/dm3s-ep3u/ https://insights.cincinnati-oh.gov/stories/s/Heroin-Overdose-Responses/dm3s-ep3u/] ===

=== Harvard Institute for Excellence in Government  (Case studies on data driven approaches) ===

[https://scholar.harvard.edu/files/janewiseman/files/data_driven_approaches_to_fighting_the_opioid_crisis_jane_wiseman_april_2019.pdf https://scholar.harvard.edu/files/janewiseman/files/data_driven_approaches_to_fighting_the_opioid_crisis_jane_wiseman_april_2019.pdf]

=== ''RxStat (New York, NY)''[3] ===

*'''Partners''': the New York City Department of Health and Mental Hygiene with their public safety partners.
*'''Approach''': RxStat consists of two general phases: collecting timely and accurate data and using the data to develop targeted interventions aimed at reducing overdose deaths.
*'''Outcomes''': Staten Island has seen a 29 percent decrease in prescription opioid deaths since officials first began implementing RxStat.

 

=== ''Project Vision (Rutland, VT)''[4] ===

*'''Partners''': Rutland Police Department (led by Chief Brian Kilcullen), elected officials, representatives from the medical field, social service providers, local businesses, criminal justice agencies, schools, nonprofit organizations, mental health providers, faith-based groups, federal and state law enforcement agencies, and other stakeholders.
*'''How it works''': RuStat meetings every other week. During the meetings, representatives from the police department present specific addresses within the community that have been the subject of three or more police visits during the previous two-week period. Project VISION members can then determine whether they are familiar with the addresses through their own work—for example, a social worker who is at the meeting may have a client at the address. From there, Project VISION partners can devise a plan to provide the person identified with the appropriate services. According to Scott Tucker, Executive Director of Project VISION, many of the crimes associated with drug use have decreased since the program started.
*'''Outcomes''': From 2014-2016, burglaries decreased by 60 percent, shoplifting decreased by 36 percent, and larcenies went down by 40 percent.
*'''Website''': [http://projectvisionrutland.com/ [1]]
*'''Contact''': [http://projectvisionrutland.com/contact/ [2]]

 

=== ''Local Overdose Fatality Review program (Maryland)'' ===

*'''Partners''': Maryland Department of Health and Mental Hygeine (DHMH), overdose fatality review teams in each county in the state.
*'''How it works''': For each overdose incident, the DHMH provides the local review team with information from the state medical examiner’s office including raw information about the death and any substances found during the medical examination and other information it can gather such as the deceased’s drug treatment records. Team members must sign a confidentiality agreement to obtain access to protected health information. The local review teams examine these data and all other information they receive about each case. Based on this review, the team develops a set of findings about what potentially could have been done to prevent the death including any missed opportunities for prevention, gaps in the system, and areas for increased collaboration among agencies and stakeholders at the local level. The team also develops recommendations for how these deficiencies could be addressed through changes in laws, policies, and protocols.The review team’s findings and recommendations are shared with officials at the state level, who use the information to inform policies and programs aimed at preventing future overdose deaths.[5]
*'''Outcomes''':
**Quality of referral systems improved
**Increased focus on outreach to families to provide overdose prevention & treatment services by local health departments and other providers
**Identification of new target audiences for Overdose Response Program (naloxone) trainings
**Increased awareness of member agency staff of overdose related issues and Overdose Response Program training for member agency staff
**Changes to intake questionnaires to include questions about overdose history
*'''Website:''' [http://bha.dhmh.maryland.gov/OVERDOSE_PREVENTION/Pages/OFR-.aspx [3]]
*'''Contact''': Erin Haas (Program Manager) [[mailto:erin.haas@maryland.gov.%20|erin.haas@maryland.gov [4]]]

=== Deloitte Center for Health Solutions (DCHS) ===

The Deloitte Center for Health Solutions, part of Deloitte LPP's Life Sciences and Health Care practice, is a source for fresh perspectives in health care. It looks deeper at the biggest industry issues and provides new thinking around complex challenges. Cutting-edge research and thought-provoking analysis give their clients the insights they need to see things differently, and address the changing landscape.[7] DCHS developed a report called, "[http://www.modernhealthcare.com/assets/pdf/CH115670524.PDF Strategies for stemming the opioid crisis]" that describes how data analytics can help health plans and pharmacy benefit managers chart their course. To learn more about the DCHS and their research, visit [http://www.deloitte.com/centerforhealthsolutions [5]].

  According to their major findings, potential strategies for health plans and pharmacy benefit managers (PBMs) include:[8]

*Leveraging data and emerging technologies
*Working toward more streamlined data collection and sharing
*Supporting the development of evidence-based standards and quality metrics to define and encourage successful treatment
*Advocating for policy changes at the federal level

 This complex, multifaceted problem calls for systematic solutions across the healthcare system.[9] Read more about [https://www2.deloitte.com/insights/us/en/industry/health-care/strategies-health-plans-pbms-to-stem-opioid-crisis-with-data-technology.html#interactive?id=us:2el:3dp:mdrnhlth:eng:lshc:060118 strategies for stemming the opioid crisis].

 

'''SUBJECT MATTER EXPERT''': [fill out table below]

Improve Data Sharing and Analysis

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#REDIRECT [[Improve Data Sharing, Analysis, and Monitoring]]

Activating Your Community

2020-12-21T16:37:42Z

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__NOTOC__ Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]   
SWITCHING TO "Activating Your Community

== Contents ==

 

 

= Background =

There are many barriers that prevent and limit the efforts of communities addressing drug misuse and substance use disorder, but one particular challenge that many communities face is the ability to elevate their initiative above other local competing priorities.  Identifying champions who can publicly support the coalition’s mission can help to build and foster strategic partnerships, generate buy-in, and increase commitment to bolster supports. With a solid understanding of the current programmatic needs in your area, you can build power and mobilize the community by successfully bringing together advocates, policymakers, and professionals to take collective action.

Whether you are developing legislative or regulatory efforts, building and strengthening programs, or attempting to reach a diverse audience with a wide range of needs, communities of all sizes should consider the following principles when activating your community around this crisis:

*Put equity at the center for your efforts
*Engage individuals with lived experience or those directly impacted by substance use disorder in decision-making roles
*Create alliances and form strategic partnerships that build political will and support from a broad range of stakeholders
*Build relationships with federal, state, and locally elected leaders
*Understand your community’s most powerful levers for change 
*Allow data to drive your strategy development and decision-making
*Focus on measurable individual and community-based outcomes
*Empower citizens by increasing public awareness and community engagement opportunities
*'''Strengthen your system or infrastructure in order to achieve impact at scale'''

It’s important to note that any community organizing or political will building strategy should be implemented with regularity - it should not be a single event or effort.  For the greatest impact, communities should show the link or intersection of substance use disorder with other competing community priorities, consistently focus on drumming up new interest, and relay progress made over time back to community stakeholders using a message of hope in order to sustain engagement.

Drug misuse and SUD has consequences for all residents of local communities.  The current epidemic increases costs related to public health, public safety, criminal justice, treatment services, and many more.  Locally elected leaders are typically motivated by the economic impacts to improve local response, but a far greater price comes from the fatalities caused by the epidemic and related overdoses and the loved ones who must face the pain of those lost.  This is what motivates many others to create and join efforts to combat the epidemic within their communities.  Many of these leaders typically work in prevention, harm reduction, treatment, recovery support services, and other efforts that save lives and help those in need find recovery, but it may be necessary for communities to tailor messaging to suit a wide variety of audiences in a manner that speaks to the receiver’s particular interest.  When identifying champions or strategic alliances, communities should consider their most powerful levers for change.  Who or what in your community can unlock opportunity and accelerate change?  What is the backbone of your community?  Is it your local hospital system, community college, or a specific business or company?  Communities may find that some individuals or organizations may have conflicting viewpoints – try to approach them and open a door for conversation.  Sometimes non-traditional partners are only “non-traditional” because we label them as such.

= Key Community Members =

== Elected Officials and Local Health Leaders ==

Locally elected leaders and health officials can play a key role in leading efforts to improve the response to the SUD epidemic.  Mayors, County Executives, County Managers, Commissioners, and the local health leaders they appoint, can be powerful allies in raising public awareness about the extent of the problem, the availability of resources, and providing information on specific strategies, like harm reduction, that can help save lives.  In many instances, elected officials and local health officials might already be part of some type of community task force or other group charged with coordinating and improving local response to the epidemic; however, in the absence of such an effort, elected and health leaders can and should be engaged in raising awareness about the issue and solutions while also increasing support within the community.  

Elected leaders, and especially legislators, play an important role in the creation of budgets and ultimately decide on how local revenues are allocated to different programs, so it is critical they are aware of the scope of these issues in their communities and what is being done in response.  In most cases, they have political allies and are regularly invited to speak at community events or participate in meetings with diverse audiences where they can help to relay your message and share information about the response.

Although locally elected leaders are important champions, it’s also critical for a coalition to work alongside its state partners to help align efforts for maximum impact, inform policy, support funding, and make recommendations on scalability of programs that are working on-the-ground to avoid duplication or manage expectations that might not be feasible or sustainable at the local level.

=== Engagement Examples - Elected and Local Health Leaders ===

== Community Stakeholders and Infuencers ==

Anyone in your community can be a leader or a champion.  Drug misuse and substance use disorder affects a substantial number of residents in all communities.  Having a wide variety of stakeholders imbedded within the community can help to advance policies, programs, and systems that can work together and improve local response.  When appropriate, consider engaging other community partners to leverage efforts and boost support within the community.  These individuals in your community who could be key champions or partners along the way, but might not necessarily participate in the coalition.  Some examples might include:

*Health Professionals and Community Health Centers
*Hospital System Administration
*Faith Leaders
*Law Enforcement or other First Responders
*Public and Private School Systems
*Colleges, Universities, and Institutions of Higher Education
*Parent Groups
*Youth and Young Adults
*Local businesses, corporations, or the Chamber of Commerce
*Philanthropic Community

== Individuals with Lived Experience ==

Communities should also engage individuals with lived experience in decision-making roles - meaning those who have had first-hand involvement with substance use disorder and those who are friends or family members of those directly impacted.  Individuals with lived experience bring knowledge, understanding, and experience not learned through formal education.  To be most effective, it is imperative that communities honor and reflect the voices of those most impacted in their programs and systems. If possible, find ways to offer fair compensation for their time.  

= Improving Pubic Awareness And Engagement =

Public education and awareness is essential to activating a local community.  Residents need to know the unvarnished reality of what is taking place.  They need to know what the problem is, and what needs to be done to improve the local response and save lives.  In addition order to be educated, local residents also need to be involved in the process.  The people are the community, and many have first-hand experience with drug misuse and SUD.  Many others have lived experience with family and friends who are struggling with these issues, and their input and participation is needed to create a Comprehensive and effective Community

 

== Public Availability of Data ==

 

== Community Education Programs ==

 

== Building Strategic Partnerships ==

 

== Develop Outreach Strategies ==

 

= Overcoming Stigma =

== Anti--Stigma Campaigns: ==

[http://www.safeproject.us/noshame SAFE Project’s #NoShame Pledge] – This virtual campaign helps to combat negative perception and offers support to others when seeking treatment or speaking up about mental health and substance use disorders.  It was designed to include a toolkit for communities who want to replicate the campaign locally and use it a community mobilizing tool to drum up political will and raise awareness about local efforts underway to combat stigma.  By using the pledge as a catalyst, communities can identify new stakeholders who can be activated and drive social impact, as well as help to change behaviors at scale.

State of Massachusetts - Sate Without StigMA. <ref>https://www.mass.gov/state-without-stigma
</ref> The State of Massachusetts has developed a comprehensive anti-stigma campaign at the State level.  This resource provides information about what stigma is, how it contributes to the current epidemic, and personal stories of people who talk about their own experiences with stigma and how they overcame it to find help for themselves and others in a variety of settings.

 

  __TOC__

[[Category:Community Resources]]

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Strengthening Your Community Coalition

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= Summary =

The substance misuse and SUD epidemic is a complex problem requiring a highly coordinated and cooperative response from communities.  The increase in non-fatal and fatal overdoses in recent years has caused many communities to realize that individual organizations cannot afford to work in silos.  Without a unified strategy and a focus on common goals, communities addressing a crisis as large as the addiction epidemic will not be poised for success. There is a clear understanding that local government, community partners of all types, and the private sector must align and work together to develop and implement effective strategies to improve their collective response to the SUD epidemic across the continuum of care.  By bringing together and working with a broad range of stakeholders, communities large and small can develop solutions that work for all those touched by the opioid and addiction crisis.  

Creating a community coalition is one of the most effective ways to solve complex problems and it is at the core of creating a local movement.  A coalition is simply a group of individuals and organizations with a common interest, who agree to see the problem through each other’s eyes and work together toward a common goal.  A coalition concentrates a community’s focus on a particular problem, creates alliances among those who might not normally work together, and keeps the community’s approach consistent. 

This page provides an overview of what it takes to build and strengthen an effective coalition based on the experiences of communities across the country.

__TOC__

= Building Your Coalition =

Many local communities have assembled coalitions to improve response to the SUD epidemic.  There is no one-size-fits-all set of practices for creating an effective coalition.  The suggestions that follow are based on the experiences of many communities and are meant to serve as a guide for those looking to form a new coalition or expand and improve upon one that already exists.  One important aspect when looking to create a coalition is to realize that, historically, substance use disorder has been seen by many as a moral failing and not a disease.  

As Mayor Nan Whaley from Dayton, Ohio, puts it, "When we began our work in Dayton, there was no blueprint for treating a substance misuse epidemic because the United States has never treated addiction as it treats other chronic illnesses."  [http://ifi-wikis.com/IFI-OpioidCrisis/Strengthen_the_Coalition_to_Reduce_Substance_Use#cite_note-1 [1]]

Dayton and other communities who have found success have embraced the fact that SUD is a chronic health illness, not a choice.  This outlook, in turn, has informed a new set of strategies that includes compassion and meeting those suffering from SUD where they are at the moment.  

 

= Getting Started =

Who can start a coalition to address SUD?  Anyone can.  Coalitions and task forces are often started by local elected leaders, public health departments, public safety agencies, community organizations, or even passionate individuals engaged in the fight to save lives and reduce harm created by drug misuse and SUD.  Typically, coalitions are formed as a response to higher rates of overdose and overdose deaths.  Regardless of who takes the initiative, it is important to be inclusive and identify stakeholders whose ultimate goals align.  Get started by looking around the community and determining if there are similar existing efforts in which to get involved or add value.  It’s important not to duplicate efforts.  Is there a mechanism or coalition body already taking a comprehensive approach to addiction that can be leveraged?  

== Potential Partners and Their Roles ==
<div class="_">
There are many potential partners that can be invited to join the coalition and improve the community response to SUD.  The following list is not intended to be all inclusive and it is not a requirement to have all of these individuals at the table.  These are suggestions based on the types of partners that are most often brought together.  Highlighted categories contain links to what roles they might play within the coalition.  Keep in mind it’s important to establish a team of optimal size and with sufficient authority to plan and implement ideas and strategies effectively and efficiently.  Does the team include leaders with the authority to make decisions and drive the implementation of new strategies?
</div>
#Local Health Departments
#Hospitals
#Pharmacists
#Primary Care Physicians
#Pain Specialists or Pain Centers
#Nurses
#Health Plans and Insurance Companies
#Local Elected Officials
#Local Law Enforcement
#Corrections
#Treatment Providers
#Faith Based Communities
#Persons with lived experience, including those in recovery and still using substances
#Local Harm Reduction Organizations
#Education Leaders
#Business Leaders
#Recovery Support Organizations
#Family Support Groups and Recovery Allies
#Local Philanthropic Organizations

== Working with Partners  ==

=== Faith-Based Communities ===

See [[Coalition_Partner_-_Faith_Communities|Coalition Partner: Faith Communities]] for more details on how members and leaders of faith communities can support strategies to address opioid abuse and recovery in their community.  [http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTcwOTIxLjc4NDQ4OTExJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDE3MDkyMS43ODQ0ODkxMSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3NDUxODE5JmVtYWlsaWQ9YmlsbC5iYXJiZXJnQGluc2lnaHRmb3JtYXRpb24uY29tJnVzZXJpZD1iaWxsLmJhcmJlcmdAaW5zaWdodGZvcm1hdGlvbi5jb20mZmw9JmV4dHJhPU11bHRpdmFyaWF0ZUlkPSYmJg==&&&103&&&https://www.hhs.gov/about/agencies/iea/partnerships/opioid-toolkit/index.html Opioid Epidemic Practical Toolkit: Helping Faith and][http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTcwOTIxLjc4NDQ4OTExJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDE3MDkyMS43ODQ0ODkxMSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3NDUxODE5JmVtYWlsaWQ9YmlsbC5iYXJiZXJnQGluc2lnaHRmb3JtYXRpb24uY29tJnVzZXJpZD1iaWxsLmJhcmJlcmdAaW5zaWdodGZvcm1hdGlvbi5jb20mZmw9JmV4dHJhPU11bHRpdmFyaWF0ZUlkPSYmJg==&&&104&&&https://www.hhs.gov/about/agencies/iea/partnerships/opioid-toolkit/index.html Community Leaders Bring Hope and Healing to Our Communities] may also be helpful. Programs like [http://www.onebodycollaboratives.org/ One Body Coll][http://www.onebodycollaboratives.org/ aboratives] and software like [https://meettheneed.org/ Meet the Need] can help engage and equip churches to participate in their communities.
<div class="_">
=== Public Health and Public Safety ===

'''Principles for Building Better Relationships''' The Police Executive Research forum reports 5 principles for building better partnerships between law enforcement agencies, public health organizations, treatment providers, and other stakeholders from their April 2016 meeting. The five principles are:

#Find common ground and work toward shared goals.
#Respect and Learn from one another's positions and perspectives
#Involve people from all levels within an organization
#Be open to expanding your perspective and accepting new roles.
#Maintain a community focus.[1]

= Organization, Structure, and Meetings =

This is another area where each coalition will determine for itself what works best for them.  However, some guidelines based on experience may be helpful.  Questions of leadership, frequency of meetings, who else should be included, the need for some type of by-laws or governance document, and the roles of participants are just some of the questions that typically arise during planning. 

Working through these and other issues requires patience and cooperation.  Many involved with this effort will be passionate and have strong opinions that others may disagree with.  Differences will arise.  How they are resolved is what matters.  It is important to have procedures that allow people to be heard and for a respectful debate to take place.  This is balanced with the need to make decisions and mover forward.  Either the group or designated leadership needs to be assertive, end debate, and make a decision by vote or executive decision.  Leaders need to remind all involved that all involved want the same thing - to save lives and reduce suffering.

== Initial Outreach ==

Getting your desired partners to the table is not always easy.  Keep in mind that while there are a number of ways to contact these groups, in-person and direct contact is always best.  You may have to overcome resistance of several types.  Organizers of local coalitions to improve response to drug misuse and SUD have often found that some potential partners are suspicious or even defensive.  Some organizations are not naturally inclined to work with others.  For example, the harm reduction and law enforcement communities are not always natural allies.  However, we have found that where these two groups come together and see the problem through each other’s lenses, some very powerful work can be done.  Some organizations might not want to get involved because of their own perception of capacity (this is more work for me) or stigma (this is not my problem).  You may have to expend considerable effort to convince these groups that reversing the epidemic is in the entire community’s interest and that everyone has a contribution to make.

It is important to build trust from the outset.  Some common advice heard from those who have been through the process of bringing together a coalition include:

     - Honoring the Work that has Been Done.  Everyone fighting this epidemic is doing their best and should always be recognized for their efforts.

     - No Judgement.  The rise of the current epidemic has been created by a series of events outside of any local jurisdiction.  It is not the fault of local government and community leaders fighting the epidemic.

     - Common Goals.  As part of initial discussions, it is important to talk about what all partners typically have in common - the desire to save lives and reduce suffering.  While partners will vary in the approaches they use, and which they may feel are more effective, all involved want to see the same end result.  It is important to focus on what the partners share in terms of outcomes they want to see and discuss how greater collaboration will benefit the efforts of all involved. 

== Initial Actions ==

Hold your first meeting.  Don’t worry if you have as few as five community leaders or as many as 20.  The important thing is, you have found people who are willing to work together to thoughtfully and comprehensively address the particular problem in your community.  Although the topic that brings all of the stakeholders together is difficult, it is the coalition leader’s job to bring energy and optimism to the movement.  Because solutions might look different to each of your stakeholders, focus on defining the common problem you are looking to solve.  A goal of your first meeting should be to establish a meeting rhythm in which the coalition frequently gathers to review progress, update your plan, and share success stories.   

== Evaluate the State of Your Community ==

For your community coalition to be successful, it will need to understand how the community perceives a number of elements of addiction, as well as what resources are already at work across the many stakeholder sets within your community.  One way to evaluate perception and resources is through the SAFE Community Pulse Survey and SAFE Community Resources Exercise.  These tools are designed specifically to provide you with the insight your coalition needs to focus and prioritize your work.  These tools can be found in [[SAFE_Project’s|SAFE Project’s Community Playbook]] – a framework for communities to organization, evaluate, and create change in their community to impact the addiction epidemic.  

Once you have completed both evaluations, it’s time to take a step back and look at what the data and research are telling you.  Is there a correlation between what the community survey tells you and the gaps that you have identified in your resource exercise?  

= Lessons Learned and Related Questions =

As you consider who to reach out to in order to create or expand a coalition, we have provided below some lessons learned by communities that have gone through - and continue to go through - this process.  As you proceed you will likely find that the needs of the coalition, as expressed by the members, will change over time.  Most often, the composition of the coalition will change as well.  The lessons are followed by questions that should be asked when considering which potential partners to include.  As a coalition leader, it might also be helpful to track lessons learned over time to help maintain institutional knowledge as staffing changes over time.

== Data is a Critical Foundation to Action   ==
<div class="_">
The improved collection, distribution, and rapid analysis of data is critically important to the development of a strategy to address areas within a community that are being severely impacted by SUD.  This typically goes far beyond just tracking overdose deaths and non-fatal overdose.  It is important to know where they are occurring in order to know where more resources need to be deployed.  What data sources are currently available?  How are they being used?  Does the coalition have the partners to provide the necessary data?  How can the coalition expand the data set to help focus resources where they are most needed, and when they are most needed?  What can be done in a short amount of time, at reasonable expense, to better collect, analyze, and make use of data related to the SUD epidemic in the region?  Use local data disaggregated by population characteristics like race, ethnicity, immigration status, language, and household levels of income to identify disparities in outcomes and inform policies and practice for specific populations, neighborhoods, and zip codes.

== Prevention Efforts Reduce First Time Use and Support other Coalition Stakeholders ==

Prevention efforts that focus on educating the community - especially youth and young adults - about the risks of drug use are an important component of an effective community coalition.  Prevention organizations have experience with messaging and building awareness campaigns that educate the community about the impacts of drug use on individuals and families.  This knowledge and experience is often helpful in developing strategies to reach specific populations and the community at large.  Prevention reaches into many other areas along the continuum of care, and they often help provide information on linkages to care, treatment options, and recovery supports.  </div>

== Harm Reduction Saves Lives and Should Provide a Linkage to Care   ==

The distribution and training of how to use naloxone continues to be an effective way to reverse opioid overdose and save lives.  Other programs, like needle/syringe exchanges, reduce the risk of infection and prevent the spread of other diseases.  Resistance to these programs is reduced when they are paired with providing information about treatment options and other available support in the community.  What training on naloxone administration is available in the area? How is this service being marketed to ensure organizations across the health system know it is available? What are the most effective ways to expand distribution of naloxone and add other harm reduction measures?  Are there ways to improve linkages to care?  What can the coalition do to reach more people, especially in areas with the highest rates of overdose, to expand harm reduction efforts?

== Agencies and Community Organizations May Need to Take on new Roles ==

There are many examples where organizations need to expand services and take on new roles to address the SUD epidemic - especially in underserved areas of the community. This might include:       

- Police working with peer recovery specialists/coaches in cases of overdose.

- Community organizations taking on prevention/education/training roles.

- Hospitals coordinating with area treatment providers to help overdose patients.  

Do new roles need to be taken on by government agencies and/or community groups?  If so, who and what new roles would be helpful?  Who should the coalition include to create new or expanded partnerships in the region?  Ideally what role(s) would they take on?

== Family Members and Related Support Groups Can be Powerful Partners   ==

Some communities have strong, well organized family support groups that provide volunteers to help carry out the work of the coalition.  Many such groups help raise awareness, reduce stigma, educate and train on the use of naloxone, and advocate for needed policy changes.   Is there an effective family group in the area?  Would greater coordination and involvement with the coalition be beneficial?  

== The Contribution of Peer Support Networks  ==

Peer Support Specialists and Recovery Coaches can play a vital role across numerous initiatives.  Working together with police, health services, treatment providers, and recovery support networks, Peer Support Specialists and Recovery Coaches often provide an initial link to care for someone seeking help after an overdose or just wanting help.  In many instances they continue to work with people for longer periods of time - helping them find and get through treatment, as well as get what they need to help them maintain recovery.  How are peers being utilized in the area?  Is there room to expand current efforts and add more peer support through additional training and funding?  If more peer specialist/coaches could be added in the region, who is needed to help make that a reality?   

== Finding Ways to Serve Underserved Areas   ==

This is an issue of major concern in most communities, and often, multiple strategies are necessary.  Stronger data collection efforts can help to more effectively direct the appropriate services to targeted areas within the community where they are most needed.  This will also help community partners in better addressing the crisis in their neighborhoods.  How can the coalition better serve areas of the community that have been underserved?  What partnerships can help make this happen effectively?  

== SUD must be seen as a Disease, not a Crime or Moral Failing   ==

Although there is growing understanding that SUD is a disease, there is still a stigma present that often prevents individuals and families from seeking help.  Stigma can also impact the type and quality of care provided by clinicians.  Stigma can be reduced through public awareness campaigns and education efforts.  If these are taking place in the community - how can these be expanded?  What organizations in the community can help this effort as part of the coalition? 

[http://www.safeproject.us/noshame SAFE Project’s #NoShame Pledge] – This virtual campaign helps to combat negative perception and offers support to others when seeking treatment or speaking up about mental health and substance use disorders.

== The Criminal Justice System Plays a Key Role   ==

It is generally recognized that a person suffering from SUD can be helped to a far greater degree through various diversion and treatment programs that can lead to a life in recovery, as opposed to long-term incarceration.  Socially and economically, this is tremendously beneficial to society.   What options are there for those in the criminal justice system in terms of diversion, drug court, treatment while incarcerated, and treatment/support services for those leaving incarceration?  Are there areas that need to be added or improved?  Given what programs currently exist, what improvements could be made within the state and local criminal justice systems in terms of additional or expanded programs to help those with SUD find treatment - either through diversion programs or treatment for those incarcerated?  Are key figures who are part of the system willing to participate in a coalition?

== Increasing Recovery Supports are Critical to Long-term Success   ==

Housing, education, child care, job training, and job placement assistance are just some of the recovery support services needed to help people in early recovery.  Without these supports, many with limited means and/or a criminal record can become frustrated and hopeless - increasing their chances of relapse.  Communities with strong supports for people newer to recovery have seen positive results.  What types of recovery support services exist in the region?  Who are the key organizations working on one or more recovery supports?  Are area employers engaged?  What about area workforce development entities?  Who can help expand these efforts as part of the coalition?

= National Coalitions =

There are many national coalitions and organization that can provide useful information and resources for local coalitions.  These national groups are widely varied and numerous.  It is therefore important to research these organizations so local coalitions can verify that their goals and priorities are aligned with any national organization they choose to become involved with.  A few examples follow, but there are many more at the national and even regional level.

'''Fed Up! Coalition to End the Opioid Epidemic''' Platform:

#Take all measures necessary to ensure that opioids and other controlled drugs are prescribed more cautiously.
#FDA must:
##Prohibit marketing of opioids for conditions where risks outweigh benefits
##Consult its advisory committees before approving any new opioids.
##Add an upper dose and a suggested duration of use on opioid labels.
##Designate naloxone an over-the-counter drug.
##Ensure that abuse-deterrent opioid formulations are NOT marketed as less addictive.
#DEA must mandate prescriber education, free of pharmaceutical industry bias, for all DEA registrants who intend to prescribe more than a 3-day supply of opioids.
#HHS, DEA, and Congress should immediately reduce barriers to buprenorphine treatment.
#Congress must increase funding for evidence-based addiction treatment.
#Congress must incentivize states to mandate prescriber use of Prescription Drug Monitoring Programs.

 '''Coalition to Optimize the Management of Pain Associated with Surgery ([http://compasfoundation.org/ COMPAS])''' Mission: To educated all those involved in pain management decisions about acute pain management strategies that minimize the need for opioids. COMPAS also will provide education on how to implement multimodal analgesic strategies and how to measure success for patients and hospitals alike. '''Community Anti-Drug Coalitions of America ([http://www.cadca.org/ CADCA])''' CADCA is the premier membership-based non-profit organization representing adult and youth coalition leaders throughout the United States and internationally - all working to make their communities safe, healthy, and drug-free. CADCA's model for community change represents a comprehensive, evidence-based, multi-sector approach to reduce underage and binge drinking, tobacco, illicit drugs and the abuse of medicines.

= Local Coalition Examples and Resources =

Once you have completed both evaluations, it’s time to take a step back and look at what the data and research are telling you.  Is there a correlation between what the community survey tells you and the gaps that you have identified in your resource exercise? 

== Dayton Ohio - Community Overdose Action Team (COAT) ==

Dayton provides an example of a highly structured coalition.  The chart below details this structure and summarizes the role of each component within the COAT.  Other local coalitions might not bas complex or highly structured, but this example helps to provide ideas of what could be considered. 

[https://cdn.americanprogress.org/content/uploads/2019/01/10055812/DaytonOpioids-fig9-693.png https://cdn.americanprogress.org/content/uploads/2019/01/10055812/DaytonOpioids-fig9-693.png]

 '''SUBJECT MATTER EXPERT''': [fill out table below]

= Sources =
</div>
[[Category:Community Resources]]